Sex Hormones and Prolactin in Female Systemic LupusErythematosus Patients

Abstract

The pathogenesis of systemic lupus erythematosus (SLE) is complex and multifactorial. Of the various proposed mechanisms, the hormonal theory is particularly attractive. Marked female predominance is evident among SLE patients.

The aim of the present work was to assess serum levels of sex hormones and prolactin in SLE female patients and to determine the correlation of these hormones with disease activity index.

This study was conducted on 30 female SLE patients and 20 healthy female subjects served as a control group. Thorough dermatological and physical examinations were done. The following investigations were done for patients: complete blood picture, erythrocyte sedimentation rate, complete urine analysis, total albumin in 24 hours urine, renal function tests, antinuclear antibodies and anti-ds DNA antibodies (by ELISA technique). Hormonal assay was done for patients and controls in mid menstrual cycle at 8:00 am to 8:30 am after overnight fast Serum. levels of dihydrotestosterone, testosterone, dehydroepiandrosterone sulfate (DHEA-S), progesterone, oestradiol and prolactin were evaluated by ELISA technique.

Our study revealed significant lower testosterone, DHEA-S, and progesterone serum levels in SLE patients versus controls. Oestradiol and prolactin serum levels were significantly higher in SLE patients. Renal patients showed significantly lower dihydrotestosterone, testosterone and progesterone serum levels and significantly higher oestradiol serum levels compared to cases without renal affection. SLE renal cases with moderate activity and haematological manifestations showed significantly lower serum levels of testosterone and progesterone and significantly higher prolactin serum levels compared to SLE renal cases with mild activity and without haematological manifestations. Each one of prolactin and oestradiol serum levels showed negative significant correlation with each one of testosterone and progesterone serum levels is SLE renal cases. SLEDAI of SLE cases with and without renal affection showed negative significant correlation with each one of DHEA-S and progesterone serum levels. Testosterone serum levels showed negative significant correlation with SLEDAI in SLE renal cases.

In conclusion: Sex hormones and prolactin expression and metabolism are different in female SLE patients compared to healthy subjects.Low serum levels of dihydrostestosterone and progesterone might be implicated in lupus nephritis of our patients. High prolactin serum levels might be related to the presence of hematological manifestations. Each one of DHEA-S and progesterone serum levels showed negative significant correlation with SLEDAI in SLE cases with or without renal affection.  Better understanding of hormonal relationship in SLE could lead to novel and improved application of hormonal immunotherapy.

Abstract

The pathogenesis of systemic lupus erythematosus (SLE) is complex and multifactorial. Of the various proposed mechanisms, the hormonal theory is particularly attractive. Marked female predominance is evident among SLE patients.

The aim of the present work was to assess serum levels of sex hormones and prolactin in SLE female patients and to determine the correlation of these hormones with disease activity index.

This study was conducted on 30 female SLE patients and 20 healthy female subjects served as a control group. Thorough dermatological and physical examinations were done. The following investigations were done for patients: complete blood picture, erythrocyte sedimentation rate, complete urine analysis, total albumin in 24 hours urine, renal function tests, antinuclear antibodies and anti-ds DNA antibodies (by ELISA technique). Hormonal assay was done for patients and controls in mid menstrual cycle at 8:00 am to 8:30 am after overnight fast Serum. levels of dihydrotestosterone, testosterone, dehydroepiandrosterone sulfate (DHEA-S), progesterone, oestradiol and prolactin were evaluated by ELISA technique.

Our study revealed significant lower testosterone, DHEA-S, and progesterone serum levels in SLE patients versus controls. Oestradiol and prolactin serum levels were significantly higher in SLE patients. Renal patients showed significantly lower dihydrotestosterone, testosterone and progesterone serum levels and significantly higher oestradiol serum levels compared to cases without renal affection. SLE renal cases with moderate activity and haematological manifestations showed significantly lower serum levels of testosterone and progesterone and significantly higher prolactin serum levels compared to SLE renal cases with mild activity and without haematological manifestations. Each one of prolactin and oestradiol serum levels showed negative significant correlation with each one of testosterone and progesterone serum levels is SLE renal cases. SLEDAI of SLE cases with and without renal affection showed negative significant correlation with each one of DHEA-S and progesterone serum levels. Testosterone serum levels showed negative significant correlation with SLEDAI in SLE renal cases.

In conclusion: Sex hormones and prolactin expression and metabolism are different in female SLE patients compared to healthy subjects.Low serum levels of dihydrostestosterone and progesterone might be implicated in lupus nephritis of our patients. High prolactin serum levels might be related to the presence of hematological manifestations. Each one of DHEA-S and progesterone serum levels showed negative significant correlation with SLEDAI in SLE cases with or without renal affection.  Better understanding of hormonal relationship in SLE could lead to novel and improved application of hormonal immunotherapy.