CEDIE   05498
CENTRO DE INVESTIGACIONES ENDOCRINOLOGICAS "DR. CESAR BERGADA"
Unidad Ejecutora - UE
congresos y reuniones científicas
Título:
Effects of Severe Hypothyroidism on Anti-mullerian Hormone (AMH) Values in a Prepubertal Boy Without Machrorquidism.
Autor/es:
GRINSPON R P; REY R.A; ROSA ENACÁN
Lugar:
Cusco
Reunión:
Congreso; XXVII Congreso Latinoamericano de Endocrinologia Pediátrica; 2018
Institución organizadora:
Sociedad Latinoamericana de Endocrinología Pediátrica
Resumen:
Background: The FSH receptor, a member of theG-protein-coupled receptor family, is highly homologous to other glycoprotein hormone receptors, like TSH receptor. Signaling of bothreceptors involves activation of adenylyl cyclase and cAMP production. Clinicaland experimental evidence suggests that promiscuous activation of the FSHreceptor may exist when TSH concentration is extremely elevated in patientswith hypothyroidism. FSH induces Sertoli cell proliferation and AMH genetranscription, however, there is no information about AMH production in patientswith long-lasting high TSH.Case presentation: A male patient was referred at 4 years of age for evaluation of short stature. Patient´sheight was 92.1 cm (-2.16 SD) and mid-parental height was -0.52 SD. Bone agewas 2 years, coinciding with the start of growth retardation. Physical examrevealed dry skin with no goiter. He was prepubertal. Testicular volume was 3ml. Stretched phallus length was 3 cm. Atdiagnosis he had a severe autoimmune hypothyroidism with TSH >1000 µUI/ml,T4 <0.5 µg/dl, FT4 <0.4 ng/dl and positive thyroid antibodies. Gonadalaxis was prepubertal (LH 0.3 mUI/ml, FSH 2.9 mUI/ml, Testosterone <10 ng/dl andProlactin 13.6 ng/ml), AMH was abnormally high at 4700 pmol/L. Given the insufficientresponse to treatment with levothyroxine, he was diagnosed with celiac diseaseand started a gluten-free diet. Levothyroxine dosewas tritiated to normalize his TSH level. The concentration of AMH gradually decreasedas TSH levels normalized. He had an appropriate catch up growth.  At diagnosis 3 m 12m Normal range TSH µUI/ml >1000 680 43 0.5-6.5 AMH pmol/L 4700 2013 1390 300-1800 In summary,we report the association of high AMH levels in a patient with long-lastinghigh TSH and AMH normalisation after successful treatment of hypothyroidism,which provides a proof-of-concept of the ability of high levels of TSH tostimulate FSH receptor and induce AMH production.