الفهرس 
Systemic lupus erythematosus
Systemic lupus erythematosus and gonadal dysfunctionOnly 14 pages are availabe for public view
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Abstract
In this study, we were concerned to assess the
relationship between hypogonadism and osteoporosis in SLE
and how far SLE status and the drugs given affect both
conditions.
We conducted this study on 36 adolescents with SLE
who are following at the Pediatric Allergy and Immunology
Clinic, Children’s Hospital, Ain Shams University. Clinical
evaluation of patients with assessment of the disease activity
using SLEDAI was done. Besides routine laboratory
investigations of SLE, measurement of FSH, LH and estradiol
in female or testosterone in male after overnight fasting before
subcutaneous Decapeptyl 0.1 mg injection and measurement of
FSH and LH after 4 hours of Decapeptyl 0.1mg subcutaneous
injection then to measure estradiol in female or testosterone in
males after 24 hours of Decapeptyl 0.1mg subcutaneous
injection. DEXA scan were done for the studied SLE patients.
The present study revealed that 9 (60%) SLE patients
with hypogonadism had osteoporosis (50%); and 6 (40%) had
Summary & Conclusion
92
normal BMD (33.3%). Both groups had a comparable age with
female predominance.
In this series, lupus patients with low BMD were
significantly older than those with normal BMD. While patients
with hypogonadism had younger age at onset of SLE than those
with normal gonadal function. We found that the studied
patients with low BMD as well as those with hypogonadism
had significantly longer duration of SLE as compared to those
with normal BMD and gonadal function.
SLEDAI was significantly higher among the studied
patients with low BMD as compared to those with normal
BMD. On the other hand, there was no significant difference in
the SLEDAI between lupus patients with hypogonadism and to
those with normal gonadal function.
Drug therapy namely cumulative steroids and
cyclophosphamide doses were comparable between patients
with low BMD as well as hypogonadism and those with normal
BMD and gonadal function. However, cumulative steroids dose
was inversely correlated significantly with Z-score of DEXA
scan.
Summary & Conclusion
93In conclusion, low BMD and hypogonadism are common
co-morbid conditions among adolescents with pediatric SLE.
Whether hypogonadism has significant adverse effect on BMD,
this remains to be studied on a wider scale. Lupus activity and
steroids seem to adversely affect BMD rather than gonadal
function. The multifactorial pathogenesis of low BMD and
hypogonadism could explain the discrepancy in the results
between different studies. We recommend assessment of
pubertal development (tanner staging and gonadal function
tests) to be routine part of the work up of SLE patients. Also,
longitudinal studies are recommended to assess the exact effect
of hypogonadism on bone mass density in SLE patients and
whether early treatment of hypogonadism can reverse