Markedly Elevated Anti-Mullerian Hormone in a Woman with Polyendocrine Metabolic Ovarian Syndrome: A Case Report

Introduction
Anti-Mullerian hormone (AMH) is a biomarker secreted by the granulosa cells of small, developing ovarian follicles, making it a reliable indicator of a woman's ovarian reserve. AMH is usually increased in polyendocrine metabolic ovarian syndrome (PMOS), traditionally described as polycystic ovary syndrome (PCOS), due to an abundance of follicles.¹ We report a PMOS woman with an alarming rise in AMH.
Case
A 28-years lady with primary infertility of 5 years' duration presented to the infertility OPD of Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. She reported an irregular menstrual cycle and progressive weight gain. Her BMI was 29 kg/m². She was euthyroid on thyroxine 50 mcg daily. Both her ovaries had polycystic morphology on transvaginal sonography, and serum AMH was 45 ng/mL. This unusually high AMH was significant enough to consider an ovarian granulosa-cell tumor. Because her tumor markers were within normal limits, she was managed with lifestyle modification, ovulation induction, and follow-up.
Conclusion
Markedly elevated AMH in a woman with PMOS should not automatically be attributed to the syndrome and warrants consideration for evaluation to rule out granulosa cell tumor of the ovary.

Anti-Mullerian hormone (AMH); Polyendocrine Metabolic Ovarian Syndrome (PMOS), Granulosa-cell tumor; Infertility

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