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Elevated AMH has been proposed as a diagnostic criterion for polycystic ovary syndrome (PCOS), yet broad clinical use is limited by assay variability and inconsistent age-specific thresholds that influence AMH levels. A rare case series is presented to discuss diagnostic challenges in women with increased AMH, including differential considerations such as PCOS with pituitary dysfunction, ovarian enlargement, and granulosa cell tumors (GCTs), and the remaining uncertainty regarding whether high AMH reflects true PCOS.","Case Report  \nAMH in PCOS and Beyond—Rare Case Series  \nRalitsa Robeva 1,2, *, Tzvetozar Mehandjiev 3, Roumen Dimitrov 4, Yuri Hranov 4, Silvia Andonova 5, Mihaela Mladenova 5,6, Atanaska Elenkova 1,2, George Hadjidekov 7,8 and Sabina Zacharieva 2  \nAcademic Editors: Giuseppe Gullo and Mara Carsote  \nReceived: 17 November 2025  \nRevised: 16 December 2025  \nAccepted: 28 December 2025  \nPublished: 1 January 2026  \nCorrection Statement: This article has been republished with a minor change. The change does not affect the scientific content of the article and further details are available within the backmatter of the website version of this article.  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Endocrinology, Faculty of Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria; [aelenkova@medfac.mu-sofia.bg](aelenkova@medfac.mu-sofia.bg)  \n2 USHATE “Acad. Iv. Penchev”, 1431 Sofia, Bulgaria; zacharieva67@gmail.com  \n3 In Vitro Gynecological Medical Center “Dimitrov”, 1750 Sofia, Bulgaria; tzvetozar2@gmail.com  \n4 Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynecology “Maichin dom”, Faculty of Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria; roumendim@abv.bg (R.D.); [yurihranov61@gmail.com](yurihranov61@gmail.com) (Y.H.)  \n5 Genetic Medico-Diagnostic Laboratory “Genica”, 1463 Sofia, Bulgaria; sandonova@netscape.net (S.A.); [mihaela.mladenova@gmail.com](mihaela.mladenova@gmail.com) (M.M.)  \n6 IMDL “Genome Center Bulgaria”, 1612 Sofia, Bulgaria  \n7 Department of Radiology, University Hospital “Lozenetz”, 1407 Sofia, Bulgaria; jordiman76@yahoo.com  \n8 Department of Physics, Biophysics and Radiology, Medical Faculty, Sofia University “St. Kliment Ohridski”, 1504 Sofia, Bulgaria  \n* [Correspondence: rali_robeva@yahoo.com or r.robeva@medfac.mu-sofia.bg](Correspondence: rali_robeva@yahoo.com or r.robeva@medfac.mu-sofia.bg); Tel.: +359-2-895-60-40  \nAbstract  \nBackground and Clinical Significance: Anti-Müllerian hormone (AMH) is a dimeric glycoprotein secreted from the granulosa cells of the preantral and small antral follicles, which has entered routine clinical practice as a valuable tool for the diagnosis of different ovarian disorders. Increased AMH levels have been recommended as a criterion for polycystic ovary syndrome (PCOS) . However, its widespread use remains limited due to analytical diversity and contradictory age-specific thresholds, among other factors that modulate AMH levels. Case Presentation: Herein, we present a rare case series of women with increased AMH levels. The difficulties in the differential diagnosis of patients with elevated AMH levels, because of PCOS combined with pituitary dysfunction, increased ovarian volume, or granulosa cell tumors (GCTs), are discussed. Conclusions: The presented rare cases of increased AMH emphasize the important role of AMH as a diagnostic marker in women with hypogonadotropic hypogonadism and granulosa cell tumors. On the other hand, it is still unknown if increased AMH produced by unusually enlarged or supernumerary ovaries should be considered as actual PCOS cases or as a specific subgroup. Additionally, the unusual case of GCTs with pronounced AMH and LH increase but normal steroids supports the pathophysiological role of AMH for the development of neuroendocrine dysfunction. Moreover, it suggests that GCTs should be considered in the differential diagnosis of chronic anovulation even in women with normal ovarian steroid production in case of unusually high AMH levels for the age. Further studies are needed to explain PCOS heterogeneity and to ensure proper differential diagnosis for every affected woman.  \nKeywords: AMH; PCOS; supernumerary ovaries; GCT  \n1. Introduction  \nAnti-Müllerian hormone (AMH) is a dimeric glycoprotein secreted from the granulosa c","cbCaisIZekC9EPis","https://ap.wps.com/l/cbCaisIZekC9EPis","pdf",1240004,11,"English","en",105,"# Abstract\n# Keywords\n# 1. 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