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

Clovis A. Silva*, Maria E. J. Deen, Marilia V. Febronio, Sheila K. Oliveira, Maria T. Terreri, Silvana B. Sacchetti, Flavio R. Sztajnbok, Roberto Marini, Maria V. Quintero, Blanca E. Bica, Rosa M. Pereira, Eloisa Bonfa, Virginia P. Ferriani, Teresa C. Robazzi, Claudia S. Magalhaes, Maria O. Hilario

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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 +/- A 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.

Original languageEnglish
Pages (from-to)1037-1043
Number of pages7
JournalRheumatology International
Volume31
Issue number8
DOIs
Publication statusPublished - Aug-2011

Keywords

  • Juvenile systemic lupus erythematosus
  • Adolescent
  • Amenorrhea
  • Gonadal function
  • Hormone
  • Prednisone
  • RISK-FACTORS
  • DISEASE-ACTIVITY
  • OVARIAN FAILURE
  • CYCLOPHOSPHAMIDE THERAPY
  • MENSTRUAL DISORDERS
  • MULTICENTER COHORT
  • CHILDHOOD
  • GLUCOCORTICOIDS
  • DAMAGE
  • INDEX

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