High serum inhibin concentration discriminates autoimmune oophoritis from other forms of primary ovarian insufficiency.

Department of Pediatrics, Obstetrics, and Reproductive Medicine, Universityof Siena, Siena, Italy.
Journal of Clinical Endocrinology &amp Metabolism (Impact Factor: 6.31). 05/2008; 93(4):1263-9. DOI: 10.1210/jc.2007-1675
Source: PubMed

ABSTRACT Primary ovarian insufficiency (POI) is defined by hypergonadotropic amenorrhea occurring before the age of 40 yr. In 4-5% of women with POI, an ovarian autoimmune process can be demonstrated.
We have determined the serum concentrations of total inhibin and inhibin B by sensitive ELISAs in 22 women with autoimmune POI (aPOI), 71 women with non-autoimmune idiopathic POI (iPOI), 77 postmenopausal women, and 90 healthy, fertile women (HW). Diagnosis of aPOI was made according to the presence of steroid cell autoantibodies and/or 17alpha-hydroxylase autoantibodies and/or cytochrome P450 side-chain cleavage autoantibodies. All aPOI patients were also positive for adrenal autoantibodies.
Total inhibin levels were significantly higher in women with aPOI (median, 281 pg/ml) than in women with iPOI (median, 74 pg/ml) or HW (median, 133.5 pg/ml) (P < 0.001). Levels of inhibin B were also significantly higher in women with aPOI (median, 109 pg/ml) than in women with iPOI (median, 18 pg/ml) (P < 0.001) or HW (median, 39 pg/ml) (P < 0.05). Serum concentrations of total inhibin and inhibin B were significantly higher in women with POI than in postmenopausal women (P < 0.001), irrespective of the presence/absence of autoantibodies. At receiver-operating characteristic analysis, cutoff values of 133 pg/ml for total inhibin and 60.5 pg/ml for inhibin B ensured 86.4% sensitivity and 81-84.5% specificity for aPOI vs. iPOI.
We conclude that a variable degree of ovarian function is preserved in women with POI and that aPOI is characterized by increased inhibin production resulting from a selective theca cell destruction, with initial preservation of granulosa cells.

  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper presents a multiagent based wide area stabilization control of electric power systems. Two types of intelligent agents are proposed to realize the proposed wide area stabilization control system: a monitoring agent for gathering required information to stabilize the target power system, a control agent which perform the actual stabilization control on the selected unit. To demonstrate the efficiency of the proposed multiagent based wide area stabilization control, experimental studies have been performed on the analog power system simulator at the research laboratory of the Kyushu Electric Power Co.
    Power System Technology, 2004. PowerCon 2004. 2004 International Conference on; 12/2004
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Revise role of hormonal basal and dynamic tests, as well as ultrasonographic measures as ovarian reserve markers, in order to provide better counseling to subfertile couples. Review of publications on the topic, with an emphasis on recent well designed articles. Currently available ovarian reserve tests do not provide sufficient evidence to be solely considered ideal, even for premature ovarian senescence patients who do not present subfertility complaints. However, these markers occupy important place in initial approach to treatment of subfertile couples, predicting unsatisfactory results that could be improved by differentiated induction schemes and reducing excessive psychological and financial burdens, and adverse effects. In order to remedy the limitations due to the scarcity of strong evidence about this topic, future studies should try to clarify predictive value of markers in groups of specific diseases-related subfertility and pay special attention to propaedeutic multivariate models including anti-Müllerian hormone and antral follicle count.
    Journal of Assisted Reproduction and Genetics 08/2008; 25(7):311-22. DOI:10.1007/s10815-008-9241-2 · 1.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The risk for premature ovarian failure increases in association with two principal known etiologies: in the presence of excessive triple CGG expansions on the FMR1 (fragile X) gene (genetic etiology) and in association with a variety of autoimmune conditions (autoimmune etiology). To what degree milder forms of premature ovarian aging are also associated with these two etiologies is, however, unknown. We, therefore, investigated 119 consecutive, so identified, infertile women and statistically correlated by linear and logistic regression analyses ovarian function parameters to markers of a possible genetic etiology (number of CGG triple repeats on the FMR1 gene) and to markers of possible abnormal immune function (immune panel). Sixty (50.4%) of 119 participants demonstrated at least one immune abnormality. Both groups did not differ statistically in age, mean follicle-stimulating hormone, estradiol, and antimüllerian hormone levels, although antimüllerian hormone suggested a trend toward higher levels in autoimmune participants (P = 0.19). Autoimmune participants also demonstrated lower mean triple CGG expansion sizes (P < 0.05) and included fewer women with greater than or equal to 35 triple repeats (relative risk, 4.0; 95% CI, 1.3-11.9; P < 0.01), previously reported to demarcate increased risk for premature ovarian aging. Even minimal evidence of abnormal autoimmune function ("immunological noise") seems to increase risk toward premature ovarian aging, often manifesting as infertility. Evidence of abnormal autoimmune function, such as increased CGG triple expansion sizes, in young women, therefore, warrants vigilance for development of prematurely diminished ovarian reserve and infertility.
    Menopause (New York, N.Y.) 02/2009; 16(4):760-4. DOI:10.1097/gme.0b013e318193c48b · 2.81 Impact Factor