Premenarchal and postmenarchal girls with insulin-dependent diabetes mellitus: Ovarian and other organ-specific autoantibodies, menstrual cycle

• Published in: Journal of pediatric & adolescent gynecology 1999-11, Vol.12 (4), p.209-214
• Main Authors: Šnajderová, Marta, Martínek, Jindřich, Hořejší, Jan, Nováková, Dana, Lebl, Jan, Koloušková, Stanislava
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Autoantibodies - blood; Autoimmune diseases; Autoimmune Diseases - complications; Autoimmune Diseases - immunology; Case-Control Studies; Child; Cohort Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - immunology; Female; Humans; IDDM; Insulin - immunology; Insulin autoantibodies; Iodide Peroxidase - immunology; Menarche - immunology; Menstrual cycle; Menstrual Cycle - immunology; Menstruation Disturbances - etiology; Menstruation Disturbances - immunology; Ovarian autoantibodies; Ovary - immunology; Prospective Studies; Thyroglobulin - immunology; Thyroid Gland - enzymology; Thyroid Gland - immunology; Thyroid peroxidase and thyroglobulin autoantibodies
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/S1083-3188(99)00023-6

Study Objective: To estimate various organ-specific autoantibodies and detect other endocrine autoimmune disorders and menstrual cycle characteristics in girls with Type 1 insulin dependent diabetes mellitus (IDDM). Design: Prospective cohort study from 1993 to 1998, duration 4.5 years. Setting: Diabetes & Endocrine Clinic of the University Hospital, Motol, Prague Patients: 53 IDDM girls (group A—43 postmenarchal, group B—10 premenarchal), 15.5±2.5 (8–19) years old, 6.2 ± 4.3 years after IDDM onset. Main Outcome Measures: Ovarian autoantibodies directed to ooplasm, zona pellucida, membrana granulosa, theca folliculi interna, and lutein cells, insulin autoantibodies, thyroid peroxidase and thyroglobulin autoantibodies. Menstrual cycle character, endocrine glands disturbance. Diabetes control, body mass index, duration of IDDM. Results: Ovarian autoantibodies in at least one of the followed structures were found in 67.9% of the IDDM girls. In the control group of 21 healthy girls of corresponding age, the positive findings in lutein cells were found in only 4.8% of the girls ( P < 0.01 versus IDDM girls). The lutein cells commonly associated with theca folliculi interna cells were the most frequent immunopositive structures in diabetic girls ( P < 0.05 versus another positive ovarian autoimmune structure). Auto-antibodies directed to ovarian steroid producing cells were frequent in IDDM patients with both irregular and normal menstrual cycles. Irregular menstrual cycles were diagnosed in 27.9% of IDDM girls, polymenorrhea in half of them, and oligomenorrhea in the remainder. Diabetes control in our patients (glycosylated hemoglobin HbA 1c in postmenarchal girls 10.1 ± 2.0%) did not differ between those with regular and those with irregular menstrual cycles. Over a follow-up period one-third of the girls with oligomenorrhea and a long-term noncompliance (HbA 1c 13.5%) developed secondary amenorrhea. Insulin autoantibodies were found in 67.8%, thyroid peroxidase autoantibodies in 12.5%, and thyroglobulin autoantibodies in 10.4% of the IDDM girls. Autoimmune thyroiditis was diagnosed in 5 IDDM patients (9.4%); hypothyroidism developed in 3 of them. Menstrual cycle was irregular in 4 of the 5 girls with autoimmune thyroiditis (polymenorrhea in 1, oligomenorrhea in another 3 girls). Conclusions: An increased incidence of various circulating autoantibodies may be markedly demonstrated in IDDM girls. Their reproductive function might have an important relationship