Gonadal function in adolescents and young women with juvenile systemic lupus erythematosus

Abstract

The authors analysed the gonadal function and age of menarche of 23 female adolescentsand young women with SLE, and correlated these with clinical, SLEDAI and therapeutic parameters. The presence of one or more clinical and laboratory parameters defined normal gonadal function: normal menstrual cycles with or without dysmenorrhea; elevated cervical mucus length; normal levels of plasma FSH, LH, estradiol, progesterone, prolactin and testosterone; normal urinary hormonal cytology; serial pelvic ultrasound compatible with ovulatory pattern; and present or previous pregnancy. The mean age of menarche (13.5§ 1.4 years) was greater than that found among 2578 healthy Brazilian adolescents (12.5§ 1.3 years; P = 0.0002). The delay in menarche correlated with an increase in the duration of the disease (P = 0.0085) and the cumulative dose of prednisone (P = 0.0013) used until the appearance of the menarche. The mean phase length in SLE was 31.5§ 10.3. Sixteen female (70%) patients showed normal and seven (30%) abnormal gonadal function. Gonadal function was not correlated with parameters of SLE. These results suggest that the patients of this study reach adulthood with a high chance of fertility.

Keywords

adolescent gonadal function hormone menarche systemic lupus erythematosus

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References

Arkachaisri T , Lehman TJA . Systemic lupus erythematosus and related disorders of childhood . Curr Opin Rheumatol 1999; 11: 384–392 .

Meltcalf MG , Skidmore D , Lowry GF , Mackenzie JA . Incidence of ovulation in the years after the menarche . J Endocrinol 1983; 97: 213–219 .

Arnalich F , Benito US , Gonzalez GP et al. Inadequate production of the progesterone in women with systemic lupus erythematosus . Br J Rheumatol 1992; 31: 247–251 .

Benito US , Harte LE , Gijon BJ , Arnalich FF . Hormonal changes in fertile women with quiescent systemic lupus erythematosus . An Med Interna 1995; 12: 221–224 .

Zapata ALC , Lotito APN , Araujo LM et al. Thyroid disorders in children and adolescents with systemic lupus erythematosus . Ann Reum Dis 1999; 58(Suppl): 1274-1274 (abstract).

Koutras DA . Disturbances of menstruation in thyroid disease . Ann NY Acad Sci 1997; 816: 280–284 .

Lim GS , Petri M , Goldman D . Menstruation and systemic lupus erythematosus (SLE): a case-control study . Arthritis Rheum 1993; 36(Suppl 5): R23-R23 (abstract).

Buyon JP , Wallace DJ . The endocrine system, use of exogenous estrogens, and the urogenital tract. In: Wallace DJ , Hahn BH (eds). Dubois' Lupus Erythematosus. Williams & Williams: Baltimore, MD , 1997, pp 817–834.

Pasoto SG , Viana VST , Mendonça BB et al. Anti-corpus luteum antibody: a novel serological marker for ovarian dysfunction in systemic lupus erythematosus . J Rheumatol 1999; 26: 1087–1093 .

10.

Boumpas DT , Austin HA , Vaughn EM . Risk of sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy . Ann Intern Med 1993; 119: 366–369 .

11.

Mok CC , Lau CS , Wong RWS . Risk factors for ovarian failure in patients with systemic lupus erythematosus receiving cyclophosphamide therapy . Arthritis Rheum 1988; 41: 831–837 .

12.

Gallant C , Kenny P . Oral glucocorticoids and their complication. A review . J Am Acad Dermatol 1986; 14: 161–177 .

13.

Jaffe SB , Jawelewicz R . The basic infertility investigation . Fertil Steril 1991; 56: 599-599 .

14.

Carr BR . Disorders of the ovaries and the female reproductive tract. In: Wilson JD , Foster DW , Kronenberg HM , Larsen PR (eds). Williams Textbook of Endocrinology. W.B. Saunders: Philadelphia, PA , 1999, pp 751–817.

15.

Giacobbe M , Pastore, AR . Infancia e adolescencia. In: Pastore AR , Cerri GG (eds). Ultra-sonogra”a. Obstetrõcia e Ginecologia. Sarvier: São Paulo , 1997, pp 631–637.

16.

Leucione L . Ciclo sexual normal y urocitograma. In: Leucione L (ed). Urocitograma. Panamericana: Buenos Aires , 1972, pp 91–100. ária Filho

17.

Scott RT , Hofman GE . Prognostic assessment of ovarian reserve . Fertil Steril 1995; 63: 7–11 .

18.

Tan EM , Cohen AS , Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1982; 25: 1271–1277 .

19.

Bombardier C , Gladma DD , Urowitz MB et al. Committee on Prognosis Studies in SLE. Derivation of the SLEDAI: a disease activity index for lupus patients . Arthritis Rheum 1992; 35: 630–640 .

20.

Marshall JC , Tanner JM . Variations in patterns of pubertal changes in boys . Arch Dis Child 1970; 45: 13–23 .

21.

Zerwes EP , Ferreira C , Zerwes FP , Horta BL . Regularidade do ciclo menstrual pós menarche . Rev Bras Ginecol Obstet 1995; 17: 76–78 .

22.

Colli AS. Crescimento e Desenvolvimento Pubertário em Crianças e Adolescentes Brasileiras. Editora Brasileira de Ciencias Ltda: São Paulo, 1988, pp 1–65.

23.

Moffitt TE , Caspi A , Belski J , Silva PA . Childhood experience and the onset of the menarche: a test of a socialbiological model . Child Devl 1992; 63: 47–58 .

24.

Pasoto SG , Mendonça BB , Bonfá E . Menstrual disturbances in patients with systemic lupus erythematosus without alkylating therapy: clinical, hormonal and therapeutic associations . Lupus 2002; 11: 175–180 .

25.

Schaller J . Lupus in childhood . Clin Rheum Dis 1982; 8: 219–228 .

26.

Geugeon A . Dynamics of human follicule growth. A morphologic perspective. In: Adashi EY , Leung PCK (eds). The Ovary. Raven Press: New York , 1993, pp 21–39.

27.

Ronchezel MV , Len CA , Spinola e Castro A et al. Thyroid function and serum prolactin levels in patients with juvenile systemic lupus erythematosus . J Pediatr Endocrinol Metab 2001; 14: 165–169 .

28.

Gordon CM . Menstrual disorders in adolescents . Ped Clin N Am 1999; 46: 519–543 .

29.

Sakakura M , Takebe K , Nakagawa S . Inhibition of luteinizing hormone secretion induced by synthetic LRH by long-term treatment with glycocorticoids in human subjects . J Clin Endocrinol 1975; 40: 774–779 .

30.

Güittrón A, Martõnez G, Forsbach G et al. Insuficiencia ovariana prematura induzida por alquilantes. Rev Invest Clin (Mex) 1982; 34: 59–61.

31.

Clements PJ , Davis J . Cytotoxic drugs: their clinical application to the rheumatic diseases . Sem Arthritis Rheum 1996; 15: 2311–2354 .

32.

Mattison DR , Chang L , Thorgeirsson SS , Shiromizu K . The effects of cyclophosphamide, azathioprine, and 6-mercaptopurine on oocyte and follicule number in C57BL=6N mice . Res Commun Chem Pathol Pharmac 1981; 31: 155–161 .

33.

Ataya KM , Moghissi K . Chemotherapy-induced premature ovarian failure: mechanism and prevention . Steroids 1989; 54: 607–626 .

34.

Byrne J , Mulvihill JJ , Myers MH et al. Effects of treatment on fertility in long-term survivors of childhood or adolescent cancer . New Engl J Med 1987; 317: 1315–1321 .

35.

Latta K , Von Schnakenburg C , Ehrich JHH . A meta-analysis of cytotoxic treatment for frequently relapsing nephrotic syndrome in children . Pediatr Nephrol 2001; 16: 271–282 .

36.

Templeton A , Fraser C , Thompson B . Infertility epidemiology and referral practice . Hum Reprod 1991; 6: 1391–1394 .

37.

Sharp PJH , Nordhein AW . Distribution model of human ovulatory cycles . J Theor Biol 1983; 10: 663–674 .