Lupus and the Endocrinal System

**63**

**Chapter 4**

**Abstract**

ovarian function

**1. Introduction**

*and Panagiotis Athanassiou*

proper management and symptom amelioration.

Endocrine Manifestations of

Systemic Lupus Erythematosus

*Ifigenia Kostoglou-Athanassiou, Lambros Athanassiou* 

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting all organ systems. It affects primarily female patients in the reproductive age. The disease has a variable course from very mild to severe and may be fatal. It is characterized by exacerbations of disease activity called flares. Estrogens seem to be involved in SLE pathogenesis as they have multiple immunomodulating properties. In SLE the autoimmune process affects the neuroendocrine axis. Stress modulates disease expression in lupus patients. The disease affects the endocrine system. Hypothyroidism occurs in SLE patients in a higher rate than that of the general population. Hyperthyroidism is also observed in SLE, however, in the rate expected for the general population. Hashimoto's thyroiditis is observed in SLE in a higher rate than that of the general population. Hyperparathyroidism is also observed in SLE, primary and secondary in the context of renal insufficiency due to lupus nephritis. Addison's disease is rare in SLE. Cushing's disease due to an adrenal adenoma has been observed, but it is rare. Ovarian function may be compromised in SLE, due to autoimmune oophoritis or drug toxicity. The recognition of endocrine disease in SLE is important as it may guide

**Keywords:** systemic lupus erythematosus, estrogens, neuroendocrine axis, stress, hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, hyperparathyroidism,

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting all organ systems [1]. It affects mainly joints, skin, blood vessels, heart, lung, kidneys, liver and the nervous system [2]. It is the prototype of systemic autoimmune diseases. In patients with SLE the immune system attacks tissues and cells leading to inflammation and damage [3]. The course of SLE is variable, and maybe either mild or severe leading sometimes to fatal damage and death [4]. The disease is characterized by periods of exacerbation, which are called flares and periods of remission [5]. SLE occurs nine times more often in the female gender mainly in the reproductive age, and it is more frequent in people of non-European descent [6]. Different types of autoantibodies are present in SLE patients [7]. The B lymphocyte is believed to play a major pathogenic role in the disease and many different autoantibodies are detected, therefore the disease is classified as a "B-cell disease" [8, 9]. However, T lymphocytes also play a role in the immunopathogenesis of SLE [10]. Because of the presence of
