Adrenal steroidogenesis and ovarian reserve in adult childhood-onset systemic lupus erytematosus patients

Author(s):Show less -

Lourenco, Daniela M. R. ^[1] ; Araujo, Daniel B. ^{[1, 2]} ; Aikawa, Nadia E. ^{[1, 3]} ; Yamakami, Lucas Y. S. ^{[3, 4]} ; Borba, Eduardo F. ^[3] ; Maciel, Gustavo A. R. ^[4] ; Soares-Junior, Jose M. ^[4] ; Baracat, Edmund C. ^[4] ; Pereira, Rosa M. R. ^[3] ; Bonfa, Eloisa ^[3] ; Silva, Clovis A. ^{[1, 3]}

Affiliation

^[1] Univ Sao Paulo, Childrens Inst, Hosp Clin HCFMUSP, Pediat Rheumatol Unit, Fac Med, Av Dr Eneas Carvalho Aguiar, 647 Cerqueira Cesar, BR-05403000 Sao Paulo, SP - Brazil

^[2] Univ Fed Pelotas, Internal Med Dept, Fac Med, Pelotas, RS - Brazil

^[3] Univ Sao Paulo, Hosp Clin HCFMUSP, Div Rheumatol, Fac Med, Sao Paulo, SP - Brazil

^[4] Univ Sao Paulo, Hosp Clin HCFMUSP, Discipline Gynecol, Fac Med, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: CLINICAL RHEUMATOLOGY; v. 40, n. 9, p. 3651-3658, SEP 2021.
• Web of Science Citations: 0

Abstract

Objective To assess overall adrenal mineralocorticoid/glucocorticoid/androgen steroidogenesis in childhood-onset systemic lupus erythematosus (cSLE) patients and the possible effect of prednisone on adrenal hormones and ovarian reserve. Methods Fifty-one adult cSLE (ACR criteria) patients and 23 healthy controls were evaluated for adrenal steroidogenesis including mineralocorticoid (progesterone, deoxycorticosterone, aldosterone), glucocorticoid (17-OHprogesterone, 11-desoxycortisol, cortisol), and androgen (dehydroepiandrosterone-sulfate, androstenedione, total testosterone, and dihydrotestosterone) hormones. Ovarian reserve assessment included follicle-stimulating hormone (FSH), estradiol, anti-Mullerian hormone, ovarian volumes, and antral follicle count. Results The median of current age {[}29.11 (19-39.8) vs. 30.8 (19.6-42.1) years, p = 0.502] was similar in adult cSLE and controls. Regarding mineralocorticoid/glucocorticoid, the median of progesterone (p = 0.003), 17-OH progesterone (p < 0.001), and 11-desoxycortisol (p = 0.036) were significantly lower in patients compared to controls. All androgen steroidogenesis hormones were reduced in the former group {[}dehydroepiandrosterone-sulfate (p < 0.001), androstenedione (p = 0.001), total testosterone (p = 0.005), and dihydrotestosterone (p < 0.001)]. Further comparison of patients with and without current use of prednisone and controls revealed a predominant impact on adrenal glucocorticoid and androgen steroidogenesis with reduced levels of 17-OH progesterone {[}0.17 (0-0.5) vs. 0.27 (0.1-2.9) vs. 0.33 (0.1-0.8) ng/mL, p < 0.001], dehydroepiandrosterone-sulfate {[}0.155 (0-0.6) vs. 0.49 (0.1-1.6) vs. 1.11 (0.1-2.6) mu g/mL, p < 0.001], androstenedione {[}0.56 (0.2-4.4) vs. 1.7 (0.5-4.5) vs. 2.33 (0.3-3.8) ng/mL, p < 0.001], total testosterone {[}12 (12-167) vs. 16 (12-28) vs. (16.5 (0-50) ng/d, p = 0.002], and dihydrotestosterone {[}92.68 (11.8-198.5) vs. 160.62 (37.9-842.1) vs. 188.3 (71.3-543.9) pg/ml, p < 0.001] in patients under this drug. In addition, patients with this therapy had reduced median ovarian volumes {[}4.14 (2-12) vs. 7.13 (2-25.7) vs. 5.18 (2.4-17.3) cm(3), p = 0.028) that was not associated with cyclophosphamide cumulative dose (p > 0.05). The median prednisone dose was 15/mg/day (2.5-40). Conclusions We provided novel evidence that cSLE patients have an overall androgen/glucocorticoid/mineralocorticoid adrenal suppression. Furthermore, low/moderate prednisone use seems to underlie these abnormalities and may also adversely affect ovarian reserve, independently of immunosuppressants. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants