Are laboratory results showing hypergonadotropism (elevated Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH)), severely decreased estradiol, and low Anti-Mullerian Hormone (AMH) valid for a 39-year-old woman with oligomenorrhea and bilateral endometrial cysts?

Laboratory Result Validity Assessment

Yes, these laboratory results are valid and should be reported to the clinician, as they are consistent with primary ovarian insufficiency (POI) or premature ovarian failure (POF), not polycystic ovary syndrome (PCOS), despite the presence of bilateral ovarian cysts. 1

Critical Analysis of the Laboratory Pattern

The hormonal profile demonstrates hypergonadotropic hypogonadism, which is the hallmark of ovarian failure rather than PCOS:

• FSH 77 IU/L: Markedly elevated, well above the diagnostic threshold for POF (>40 IU/L) 1
• LH 31 IU/L: Elevated, consistent with loss of negative feedback from ovarian hormones 1
• Estradiol <5 pg/mL: Severely suppressed, indicating minimal ovarian follicular activity 1
• AMH 0.015 ng/mL: Profoundly low, far below the POF diagnostic threshold of 0.075 ng/mL (sensitivity 81.7%, specificity 94.4%) 1

This pattern is internally consistent and biologically coherent, showing complete loss of ovarian reserve with compensatory pituitary hyperactivity. 1

Why This is NOT PCOS

The bilateral ovarian cysts described are not polycystic ovarian morphology (PCOM) characteristic of PCOS:

• PCOS requires elevated or normal AMH: Women with PCOS typically have AMH levels significantly higher than normal ovulatory women, often >20-30 pmol/L (approximately 2.8-4.2 ng/mL) 2
• PCOS shows normal or low-normal FSH: The Rotterdam criteria for PCOS would show FSH in the normal range, not markedly elevated 2, 3
• PCOS demonstrates adequate estradiol: Women with PCOS maintain estradiol production, not the profound suppression seen here 2

Alternative Diagnosis to Consider

The bilateral cysts with this hormonal pattern suggest a gonadotropin-secreting pituitary adenoma must be ruled out:

• FSH-secreting pituitary macroadenomas can present with oligomenorrhea and bilateral multicystic ovaries despite paradoxically "normal" or only mildly elevated FSH levels in some cases 4
• However, the profoundly low AMH and estradiol in this case make pituitary adenoma less likely, as these tumors typically maintain some ovarian stimulation 4
• Recommend brain MRI to exclude pituitary pathology, especially given the disproportionately high FSH relative to LH 4

Clinical Recommendations for the Pathologist

Report these results immediately with the following interpretive comment:

• Laboratory findings consistent with primary ovarian insufficiency/premature ovarian failure 1
• The combination of FSH >40 IU/L and AMH <0.075 ng/mL has high diagnostic accuracy for POF 1
• Bilateral ovarian cysts in this context are NOT consistent with PCOS and may represent:
  • Residual follicular structures in failing ovaries
  • Gonadotropin-driven cyst formation (recommend pituitary imaging) 4
  • Autoimmune oophoritis (consider adrenal antibody testing) 5

Quality Control Considerations

The results should be verified using the following approach:

• Confirm AMH measurement was performed using automated electrochemiluminescence immunoassay (Beckman Coulter Access), which has superior sensitivity and reproducibility compared to manual ELISA 1
• Verify FSH and LH were measured during early follicular phase or at least 4 weeks after last menstrual period 2
• Repeat FSH measurement is recommended to confirm POF diagnosis, as single measurements can have false positives 2
• Consider measuring FSH on two separate occasions at least one month apart if clinical suspicion for POF is high 2

Prognostic Implications

The combined FSH + AMH pattern has near-perfect diagnostic accuracy:

• The area under ROC curve (AUC) for serum AMH + FSH in diagnosing POF approaches 1.0, indicating excellent diagnostic performance 1
• AMH shows negative correlation with FSH (r = -0.476, P < 0.05) and positive correlation with estradiol (r = 0.291, P < 0.05), confirming the biological coherence of these results 1
• This patient has essentially no ovarian reserve and would have extremely poor prognosis for natural fertility 1

These results are valid, clinically significant, and require urgent communication to the treating clinician for appropriate management and further evaluation.