Sexuality and Fertility in Women with Addison’s Disease

• Published in: The journal of clinical endocrinology and metabolism 2010-09, Vol.95 (9), p.4354-4360
• Main Authors: Erichsen, Martina M., Husebye, Eystein S., Michelsen, Trond M., Dahl, Alv. A., Løvås, Kristian
• Format: Article
• Language: English
• Subjects: Addison Disease - blood; Addison Disease - complications; Addison Disease - epidemiology; Addison Disease - physiopathology; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Aged, 80 and over; Androgens - blood; Biological and medical sciences; Case-Control Studies; Endocrinopathies; Feeding. Feeding behavior; Female; Fertility - physiology; Fundamental and applied biological sciences. Psychology; Humans; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pregnancy; Pregnancy Rate; Primary Ovarian Insufficiency - blood; Primary Ovarian Insufficiency - complications; Primary Ovarian Insufficiency - epidemiology; Sexual Dysfunction, Physiological - blood; Sexual Dysfunction, Physiological - complications; Sexual Dysfunction, Physiological - epidemiology; Sexuality - physiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2010-0445

Context: Females with primary adrenal insufficiency (Addison’s disease) have reduced levels of circulating androgens, which are allegedly important for sexual functioning. Objective: The aim was to determine peripheral androgen status, sexual functioning, and birth rates in Addison’s disease females. Design: In a postal survey, all 269 females in the Norwegian Addison’s registry were invited to complete the Sexual Activity Questionnaire (SAQ) and registration of childbirths. Blood samples were analyzed for 5α-androstane-3α,17β-diol-3-glucuronide (3α-Diol-G) and compared with blood donor levels. The SAQ scores were compared with 740 age-matched controls from the general population and 234 women subjected to risk-reducing salpingo-oophorectomy. Fertility was estimated as standardized incidence ratio for birth; the expected number of births was estimated from population statistics. Results: The SAQ was completed by 174 (65%) of the Addison’s patients. Those not taking DHEA had significantly lower 3α-Diol-G levels than blood donors (mean, 0.53 vs. 2.2 ng/ml; P < 0.0001), whereas those on DHEA treatment had elevated levels (mean, 5.8 vs. 2.2 ng/ml; P = 0.002). The Addison’s disease females were equally sexually active as the controls, but they reported significantly higher pleasure and less discomfort. They reported lower pleasure but less discomfort than the risk-reducing salpingo-oophorectomy women. The fertility was significantly reduced in females with Addison’s disease; 54 children were born to mothers with established diagnosis (87.5 expected), yielding a standardized incidence ratio for birth of 0.69 (confidence interval, 0.52–0.86). Conclusion: Despite androgen depletion, females with Addison’s disease do not report impaired sexuality. The fertility is reduced after the diagnosis is made; the reasons for this remain unknown. Despite their androgen depletion, female patients with Addison’s disease do not report impaired sexuality but experience reduced fertility.