New perspectives in the diagnosis of pediatric male hypogonadism: the importance of AMH as a Sertoli cell marker

GRINSPON, R.; REY, RA

ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA

SBEM-SOC BRASIL ENDOCRINOLOGIA & METABOLOGIA

Año: 2011 vol. 55 p. 512 - 519

0004-2730

Sertoli cells are the most active cell population in the testis during infancy and childhood. In these periods of life, hypogonadism can only be evidenced without stimulation tests if Sertoli cell function is assessed. AMH is a useful marker of the prepubertal Sertoli cell activity and number. Serum AMH is high from fetal life until mid-puberty. Testicular AMH production increases in response to FSH and is potently inhibited by androgens. Serum AMH is undetectable in anorchid patients. In primary or central hypogonadism affecting the whole gonad established in fetal life or childhood, serum AMH is low. Conversely, when hypogonadism only affects Leydig cells (e.g. LHb mutations, LH/CG receptor or steroidogenic enzyme defects), serum AMH is normal or high. In males of pubertal age with central hypogonadism, AMH is low for Tanner stage –reflecting lack of FSH stimulus–, but high for age –indicating lack of testosterone inhibitory effect. Treatment with FSH provokes an increase in serum AMH, whereas hCG administration increases testosterone levels which down-regulate AMH. In conclusion, assessment of serum AMH is helpful to evaluate gonadal function, without need for stimulation tests, and orientates the aetiological diagnosis of paediatric male hypogonadism. Furthermore, serum AMH is an excellent marker of FSH and androgen action in the testis.