Müllerian Inhibiting Substance

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Subject: Müllerian Inhibiting Substance

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Definition

  • The primary function of müllerian inhibiting substance (MIS) is to initiate regression of müllerian structures in males as a part of normal sexual development. Secreted by the Sertoli cells of the testes during embryogenesis of the male fetus. It is also expressed by granulose cells of the ovary during reproductive years and controls the primary follicles by inhibiting the excessive follicular development by FSH. Other names: anti-müllerian hormone, müllerian inhibiting hormone.

  • Normal range: see Table 16.57.

 
TABLE 16–57
Normal Ranges for Müllerian-Inhibiting Substance

Use

  • Specific and sensitive marker for the presence of testicular tissue in boys with cryptorchidism.

  • When measured either alone or in tandem with measurement of hCG-stimulated testosterone, MIS levels can be used to guide the treatment of these patients.

  • Evaluation of the presence of any functioning testicular tissue in infants and children with ambiguous genitalia.

  • Early detection of recurrence in patients with ovarian granulosa cell tumors.

  • Assess the condition of PCO and premature ovarian failure.

  • Assess ovarian reserve.

Interpretation

Increased In

  • PCOS (polycystic ovarian syndrome)

Decreased In

  • Anorchia

  • Abnormal or absence of testis

  • Pseudohermaphroditism

  • Syndrome of persistent müllerian ducts, despite the presence of structurally normal testes

Limitations

  • Compared with white women, average MIS values were lower among black (25.2% lower) and Hispanic (24.6% lower) women.

  • Menopausal women or women with premature ovarian failure have very low levels.

  • Not well-standardized test and not specific for malignancy. Interpretation needs to be in conjunction with clinical symptoms.

 
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