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Hormone profile in juvenile systemic lupus erythematosus with previous or current amenorrhea

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Abstract

To identify the underlying mechanism of amenorrhea in juvenile systemic lupus erythematosus (JSLE) patients, thirty-five (11.7%) JSLE patients with current or previous amenorrhea were consecutively selected among the 298 post-menarche patients followed in 12 Brazilian pediatric rheumatology centers. Pituitary gonadotrophins [follicle-stimulating hormone (FSH) and luteinizing hormone (LH)] and estradiol were evaluated in 32/35 patients, and prolactin and total testosterone in 29/35 patients. Patient’s medical records were carefully reviewed according to demographic, clinical and therapeutic findings. The mean duration of amenorrhea was 7.2 ± 3.6 months. Low FSH or LH was observed in 7/32 (22%) JSLE patients and normal FSH or LH in 25 (78%). Remarkably, low levels of FSH or LH were associated with higher frequency of current amenorrhea (57% vs. 0%, P = 0.001), higher median disease activity (SLEDAI) and damage (SLICC/ACR-DI) (18 vs. 4, P = 0.011; 2 vs. 0, P = 0.037, respectively) and higher median current dose of prednisone (60 vs. 10 mg/day, P = 0.0001) compared to normal FSH or LH JSLE patients. None of them had decreased ovarian reserve and premature ovarian failure. Six of 29 (21%) patients had high levels of prolactin, and none had current amenorrhea. No correlations were observed between levels of prolactin and SLEDAI, and levels of prolactin and SLICC/ACR-DI scores (Spearman′s coefficient). We have identified that amenorrhea in JSLE is associated with high dose of corticosteroids indicated for active disease due to hypothalamic-pituitary-ovary axis suppression.

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Acknowledgments

This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico–CNPQ (grants 300248/2008-3 to CAAS, 305468/2006-5 to EB, and 301487/2007-3 to MOH) and Federico Foundation Grant to EB. The authors thank the Brazilian Society of Rheumatology and the Brazilian Society of Paediatric, and the following pediatric rheumatologists for evaluating their patients: Rozana G. Almeida, Adriana R. Fonseca, Edson M. Yamashita, Marcos V. Ronchezel, Luciene L. Campos, Simone Appenzeller, Ana B. Santos, Ana C. Medeiros, Luciana M. Carvalho and Silvana P. Cardin. Our gratitude to Ulysses Doria Filho for performing the statistical analysis. This paper was primarily developed in Paediatric Department of Faculdade de Medicina da Universidade de São Paulo, Brazil, in collaboration with a Graduate Student of the Medical Faculty of the Rijks Universiteit Groningen, Netherlands.

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Authors and Affiliations

  1. Pediatric Rheumatology Unit, Instituto da Criança and Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Rua Araioses, 151/82, Vila Madalena, São Paulo, SP, 05442-010, Brazil

    Clovis A. Silva & Marilia V. Febrônio

  2. Rijks Universiteit Groningen, Groningen, Netherlands

    Maria E. J. Deen

  3. Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Sheila K. Oliveira

  4. Pediatric Rheumatology Service, Universidade Federal de São Paulo, São Paulo, SP, Brazil

    Maria T. Terreri

  5. Pediatric Rheumatology Unit, Santa Casa de São Paulo, São Paulo, SP, Brazil

    Silvana B. Sacchetti

  6. Pediatric Rheumatology Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Flavio R. Sztajnbok

  7. Pediatric Rheumatology Unit, Universidade Estadual de Campinas, Campinas, SP, Brazil

    Roberto Marini

  8. Pediatric Rheumatology Unit, Santa Casa de Belo Horizonte, Belo Horizonte, RJ, Brazil

    Maria V. Quintero

  9. Division of Rheumatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Blanca E. Bica

  10. Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

    Rosa M. Pereira & Eloisa Bonfá

  11. Pediatric Rheumatology Unit, Universidade de São Paulo, Ribeirão Preto, SP, Brazil

    Virginia P. Ferriani

  12. Pediatric Rheumatology Unit, Hospital São Rafael, Salvador, BA, Brazil

    Teresa C. Robazzi

  13. Pediatric Rheumatology Unit, Universidade Estadual Paulista, Botucatu, SP, Brazil

    Claudia S. Magalhães

  14. Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, SP, Brazil

    Maria O. Hilário

Authors
  1. Clovis A. Silva
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  2. Maria E. J. Deen
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  3. Marilia V. Febrônio
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  8. Roberto Marini
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  12. Eloisa Bonfá
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  14. Teresa C. Robazzi
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  15. Claudia S. Magalhães
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  16. Maria O. Hilário
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Correspondence to Clovis A. Silva.

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Silva, C.A., Deen, M.E.J., Febrônio, M.V. et al. Hormone profile in juvenile systemic lupus erythematosus with previous or current amenorrhea. Rheumatol Int 31, 1037–1043 (2011). https://doi.org/10.1007/s00296-010-1389-2

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  • DOI: https://doi.org/10.1007/s00296-010-1389-2

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