Información de la revista
Vol. 2. Núm. S3.
Esclerosis sistémica
Páginas S37-S41 (noviembre 2006)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 2. Núm. S3.
Esclerosis sistémica
Páginas S37-S41 (noviembre 2006)
Acceso a texto completo
Alteraciones endocrinas en la esclerosis sistémica
Endocrinological alterations in systemic sclerosis
Visitas
10577
Olga Lidia Vera-Lastraa,
Autor para correspondencia
olgavera62@yahoo.com.mx

Correspondencia: Dra. O.L. Vera-Lastra. Departamento de Medicina Interna. Hospital de Especialidades. Centro Médico Nacional La Raza. Seris y Zaachila, s/n. Col. La Raza. CP 02990 México DF. México.
, Luis J. Jarab
a Departamento de Medicina Interna. Hospital de Especialidades Dr. Antonio Fraga Mouret. Universidad Autónoma de México. México. DF. México
b División de Investigación. Hospital de Especialidades Dr. Antonio Fraga Mouret. Universidad Autónoma de México. México. DF. México
Este artículo ha recibido
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Resumen

En la esclerosis sistémica, se ha comunicado frecuencias de las alteraciones tiroideas (hipotiroidismo clínico y subclínico) y los anticuerpos antitiroglobulina de hasta el 43 y 73%, respectivamente, y en su patogenia participan mecanismos estructurales, autoinmunitarios y genéticos. Se debe investigar el hipotiroidismo clínico y subclínico e iniciar tratamiento con levotiroxina. La frecuencia de hiperprolactinemia en esta entidad es del 13 al 59% y los mecanismos implicados son la disfunción hipotálamica y los prolactinomas. La frecuencia de los prolactinomas es de hasta el 66%. Las frecuencias de osteopenia y osteoporosis son del 3 al 35% y del 35 al 44%, respectivamente. La osteoporosis en la esclerodermia es multifactorial (isquemia, inmovilización, síndrome de absorción intestinal deficiente, menopausia, esteroides, hiperprolactinemia, entre otros). Es importante realizar densitometría ósea en estos pacientes para identificar los casos de osteoporosis e iniciar un tratamiento oportuno.

Palabras clave:
Esclerosis sistémica
Hipotiroidismo
Hiperprolactinemia
Prolactinomas
Osteoporosis

In systemic sclerosis, the frequency of thyroid derangements (clinical and subclinical hypothyroidism) is 43 and 73% respectively; in its pathogenesis participate structural, autoimmune and genetic mechanisms. It is important to run thyroid function test and to investigate the manifestation of clinical and subclinical hypothyroidism and to initiate treatment with levothyroxine.

The frequency of hyperprolactinemia in SS goes from 13 to 59% and the implied mechanisms are the hypothalamic dysfunction and prolactinomas. The frequency of prolactinomas runs up to 66%. The frequency of osteopenia and osteoporosis is from 3 to 35 and from 35 to 44% respectively. The osteoporosis in escleroderma is multifactorial (ischemia, immobilization, intestinal malabsorption syndrome, steroids, menopause, hyperprolactinemia, among other). It is important to erform bone densitometry in these patients and to identify the cases of osteoporosis and to start opportune treatment.

Key words:
Systemic sclerosis
Hypothyroidism
Hyperprolactinemia
Prolactinomas
Osteoporosis
El Texto completo está disponible en PDF
Bibliografía
[1.]
J.R. Seibold.
Scleroderma.
Textbook of Rheumatology, 5.ª ed., pp. 1133-1162
[2.]
O. Vera Lastra.
Esclerosis sistémica.
Med Int Mex, 22 (2006), pp. 231-245
[3.]
V.D. Steen, T.A. Medsger.
Epidemiology and natural history of systemic sclerosis.
Rheum Dis Clin North Am, 16 (1990), pp. 1-10
[4.]
J. Lekakis, M. Maurikaki, C. Papamichael, S. Papaziglous, O. Economou, I. Scotiniotis, et al.
Short-term estrogen administration improves abnormal endothelial function in women with systemic sclerosis and Raynaud’s phenomenon.
Am Heart J, 136 (1998), pp. 905-912
[5.]
G. La Montagna, A. Baruffo, G. Bouno, G. Valentini.
Dehydroepiandrosterone sulphate serum levels in systemic sclerosis.
Clin Exp Rheumatol, 19 (2001), pp. 21-26
[6.]
I. Molnar, C. Czirjak.
Euthyroid sick syndrome and inhibitors effect of sera on the activity of thyroid 5’-deiodinase in systemic sclerosis.
Clin Exp Rheumatol, 18 (2000), pp. 719-724
[7.]
R.H. Straub, M. Zeuner, G. Lock, J. Schoelmerich.
High prolactin and low dehidro-epiandrosterone sulphate serum levels in patients with severe systemic sclerosis.
Br J Rheumatol, 36 (1997), pp. 426-432
[8.]
J. Czuwara-Ladykowska, J. Sicinska, M. Olszewska, I. Uhrynowska-Tyszkiewicz, L. Rudnicka.
Prolactin synthesis by lymphocytes from patients with systemic sclerosis.
Biomed Pharmacother, 60 (2006), pp. 152-155
[9.]
J. Parada-Turska, B. Targonska-Stepniak, M. Majdan.
Prolactin in connective tissue diseases.
Postepy Hig Med Dosw, 60 (2006), pp. 278-285
[10.]
E. Gore-Hyer, J. Pannu, E.A. Smith, G. Grotendorst, M. Trojanowska.
Selective stimulation of collagen synthesis in the presence of co-stimulatory insulin signalling by connective tissue growth factor in scleroderma fibroblasts.
Arthritis Rheum, 48 (2003), pp. 798-806
[11.]
M. El-Salhy, O. Suhr, A. Danielsson.
Peptide YY in gastrointestinal disorders.
Peptides, 23 (2002), pp. 397-402
[12.]
W.A. D’Angelo, J.F. Fries, A.T. Masi, L.E. Shulman.
Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls.
Am J Med, 46 (1969), pp. 428-440
[13.]
M.B. Gordon, I. Klein, A. Dekker, G.P. Rodnan, T.A. Medsger Jr.
Thyroid disease in progressive systemic sclerosis: increased frequency of glandular fibrosis and hypothyroidism.
Ann Intern Med, 95 (1981), pp. 431-435
[14.]
L.E. Kahl, T.A. Medsger Jr, I. Klein.
Prospective evaluation of thyroid function in patients with systemic sclerosis (scleroderma).
J Rheumatol, 13 (1986), pp. 103-107
[15.]
M.F. Besancon, L. Guzman, M. Grisanti, J. Basualdo, M.A. Alvarado, O. Rendic, et al.
Thyroid disease in progressive systemic sclerosis.
Rev Med Chil, 118 (1990), pp. 388-391
[16.]
R.M. Innocencio, J.H. Romaldini, L.S. Ward.
Thyroid autoantibodies in autoimmune diseases.
Medicina (B Aires), 64 (2004), pp. 227-230
[17.]
M. Molteni, M. Barili, N. Eisera, S. Scrofani, B. Mascagni, C. Zulian, et al.
Anti-thyroid antibodies in Italian scleroderma patients: association of anti-thyroid peroxidase (anti-TPO) antibodies with HLA-DR15.
Clin Exp Rheumatol, 15 (1997), pp. 529-534
[18.]
O. Vera Lastra, G. Resendiz, G. Medina, M.P. Cruz, R. Ariza, L.J. Jara.
Prevalence of subclinic thyroid disease in mexican systemic sclerosis patients.
J Rheumatol, 33 (2006), pp. 411
[19.]
L. De Keyser, D.C. Narhi, D.E. Furst, A.K. Huberman, R. Ross, J. Clements, et al.
Thyroid dysfunction in a prospectively followed series of patients with progressive systemic sclerosis.
J Endocrinol Invest, 13 (1990), pp. 161-169
[20.]
E. Biro, Z. Szekanecz, L. Czirjak, K. Danko, E. Kiss, N.A. Szabo, et al.
Association of systemic and thyroid autoimmune diseases.
Clin Rheumatol, 25 (2006), pp. 240-245
[21.]
L. Punzi, C. Betterle.
Chronic autoimmune thyroiditis and rheumatic manifestations.
Joint Bone Spine, 71 (2004), pp. 275-283
[22.]
M. Yamamoto, Y. Fuwa, K. Chimori, N. Yamakita, S. Sakata.
A case of progressive systemic sclerosis (PSS) with silent thyroiditis and anti-bovine thyrotropin antibodies.
Endocrinol Jpn, 38 (1991), pp. 265-270
[23.]
J.M. Sánchez de Rivera, F.J. Barbado Hernández, J.J. Vázquez Rodríguez, A. Gil Aguado, J. García Puig, J.M. Viguer García-Moreno.
Scleroderma with traces of disseminated lupus erythematosus associated with Hashimoto’s thyroiditis and papillary carcinoma of the thyroid gland.
Med Clin (Barc), 73 (1979), pp. 342-346
[24.]
S. Stagi, T. Giani, G. Simonini, F. Falcini.
Thyroid function, autoimmune thyroiditis and celiac disease in juvenile idiopathic arthritis.
Rheumatology (Oxford), 44 (2005), pp. 517-520
[25.]
B. Farzati, G. Mazziotti, G. Cuomo, M. Ressa, F. Sorvillo, G. Amato, et al.
Hashimoto’s thyroiditis is associated with peripheral lymphocyte activation in patients with systemic sclerosis.
Clin Exp Rheumatol, 23 (2005), pp. 43-49
[26.]
A.A. Shahin, S. Abdoh, M. Abdelrazik.
Prolactin and thyroid hormones in patients with systemic sclerosis: correlation with disease manifestations and activity.
Z Rheumatol, 61 (2002), pp. 703-709
[27.]
Vera Lastra O. Hipotiroidismo. En: Ramiro M, Halabe J, editores. El Internista. 3.ª ed. México: McGraw-Hill Interamericana; 2006 [en prensa].
[28.]
O.L. Vera Lastra.
Enfermedades tiroideas.
Medicina Interna en la Mujer, pp. 89-107
[29.]
W. Seigmund, K. Spiekert, A.I. Weike, T. Giessmann, C. Modess, T. Dabers, et al.
Replacement therapy with levothyroxine plus triiodothyronine (bioavailable molar ratio 14:1) is not superior to thyroxina alone to improve well-being and cognitive performance in hypothyroidism.
Clin Endocrinol, 60 (2004), pp. 750-757
[30.]
G.R. Wilson, R.W. Curry Jr.
Subclinical thyroid disease.
Am Fam Physician, 72 (2005), pp. 1517-1524
[31.]
M.I. Surks, E. Ortiz, G.H. Daniels, C.T. Sawin, N.F. Col, R.H. Cobin, et al.
Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.
JAMA, 291 (2004), pp. 228-238
[32.]
D.S. Cooper, R. Halpern, L.C. Wood, A.A. Levin, E. Chester Ridgway.
L-tiroxine therapy in subclinical hypothyroidism.
Ann Intern Med, 101 (1984), pp. 18-24
[33.]
J.V. Parle, J.A. Franklyn, K.W. Cross, S.R. Jones, M.C. Sheppard.
Circulating lipids and minor abnormalities of thyroid function.
Clin Endocrinol (Oxf), 37 (1992), pp. 411-414
[34.]
D.C. Bauer, B. Ettinger, W.S. Browner.
Thyroid functions and serum lipids in older women: a population-based study.
Am J Med, 104 (1998), pp. 546-551
[35.]
G.J. Canaris, N.R. Monowitz, G. Mayor, E.C. Ridgway.
The Colorado thyroid disease prevalence study.
Arch Intern Med, 160 (2000), pp. 526-534
[36.]
F. Monzani, N. Carraccio, M. Kozakowa, A. Dardano, F. Vittone, A. Virdis, et al.
Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: a double-blind, placebo-controlled study.
J Clin Endocrinol Metab, 89 (2004), pp. 2099-2106
[37.]
A.E. Hak, H.A. Pols, T.J. Visser, H.A. Drexhage, A. Hofman, J.C. Witteman.
Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam study.
Ann Intern Med, 123 (2000), pp. 270-278
[38.]
B. Biondi, E.A. Palmieri, G. Lombardi, S. Fazio.
Effects of subclinical thyroid dysfunction on the heart.
Ann Intern Med, 137 (2002), pp. 904-914
[39.]
N. Rodondi, A.B. Newman, E. Vittinghoff, N. Rekeneire, S. Satterfield, T.B. Harris, et al.
Suclinical hypothyroidism and risk of heart failure, other cardiovascular events, and death.
Arc Unt Med, 28 (2005), pp. 2460-2466
[40.]
D.S. Cooper.
Subclinical hypothyroidism.
N Engl J Med, 345 (2001), pp. 260-265
[41.]
A.D. Toft.
Thyroid hormone replacement. One hormone or two?.
N Engl J Med, 340 (1999), pp. 469-470
[42.]
W.P. Follansbee, O.C. Marroquin.
Cardiac involvement in systemic sclerosis.
Systemic sclerosis, 2.ª ed., pp. 195-220
[43.]
V. Steen.
Treatment of systemic sclerosis.
Curr Opin Rheumatol, 3 (1991), pp. 979-985
[44.]
R.F. Gledhill, P.H. Dessein, C.A. Van der Merwe.
Treatment of Raynaud’s phenomenon with triiodothyronine corrects co-existent autonomic dysfunction: preliminary.
Postgrad Med J, 68 (1992), pp. 263-267
[45.]
E. Ghayad, A. Tohme, F. Haddad, C. Haddad, R. Choueiry.
Scleroderma with anomalies of the thyroid function. 7 cases.
Ann Med Interne (Paris), 148 (1997), pp. 307-310
[46.]
M.C. Mourier-Clavreul, H. Rousset, A. Claudy.
Scleroderma and thyroid diseases.
Ann Dermatol Venereol, 116 (1989), pp. 701-706
[47.]
M. Shoaleh-var, A.H. Momtaz, C. Jamshidi.
Scleroderma and hyperthyroidism.
JAMA, 235 (1976), pp. 752-753
[48.]
J.A. Ward, J.D. Mendeloff, J.C. Coberly.
Hypertiroidism followed by scleroderma.
JAMA, 237 (1977), pp. 1123
[49.]
D. Nicholson, S. White, A. Lipson, R.P. Jacobs, D.G. Borenstein.
Progressive systemic sclerosis and Grave’s disease.
Arch Internn Med, 146 (1986), pp. 2350-2352
[50.]
O. Vera Lastra, L.J. Jara, L.R. Espinoza.
Prolactin and autoimmunity.
Autoinmunity Rev, 1 (2002), pp. 360-364
[51.]
S.E. Walker.
Impared hypothalamic function, prolactinomas, and autoimmune diseases.
J Rheumatol, 33 (2006), pp. 1036-1037
[52.]
C. Hilty, P. Bruhlmann, H. Sprott, R.E. Gay, B.A. Michel, S. Gay, et al.
Altered diurnal rhythm of prolactin in systemic sclerosis.
J Rheumatol, 27 (2000), pp. 2160-2165
[53.]
E.J. Kucharz, R. Jarczyk, G. Jonderko, J. Rubisz-Brezezinska, L. Brzezinska-Wcislo.
High level of prolactin in patients with systemic sclerosis.
Clin Rheumatol, 15 (1996), pp. 314
[54.]
O. Vera Lastra, L.J. Jara, G. Medina, J.L. Rojas, F. Velásquez, A. Normandia, et al.
Functional hyperprolactinemia and hypophyseal microadenoma in systemic sclerosis.
J Rheumatol, 33 (2006), pp. 1088-1112
[55.]
Consensus development conference: Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med. 1993;94:646-50.
[56.]
M.C. Nevitt.
Epidemiology of osteoporosis.
Rheum Dis Clin North Am, 20 (1994), pp. 535-539
[57.]
J. Serup, H. Hagdrup, E Tvedgaard.
Bone mineral content in systemic sclerosis measured by photonabsorptiometry.
Acta Derm Venereol, 63 (1983), pp. 235-237
[58.]
G. La Montagne, M. Vatti, G. Valenti, G. Tirri.
Osteopenia in systemic sclerosis: evidence of a participating role of early menopause.
Clin Rheum, 10 (1991), pp. 18-22
[59.]
J. Louks, J. Pope.
Osteoporosis in scleroderma.
Sem Arthritis Rheum, 34 (2004), pp. 678-682
[60.]
K. Neumann, D.J. Wallace, A.L. Metzger.
Osteoporosis – less than expected in patients with scleroderma.
J Rheumatol, 27 (2000), pp. 1822-1823
[61.]
L. Carbone, F. Tylavsky, J. Wan, McKown, S. Cheng.
Bone mineral density in scleroderma.
Rheumatology, 38 (1999), pp. 371-372
[62.]
O. Vera Lastra, B. Croes Araque, E. Altamirano Bustamante, R. Ariza Andraca, L.J. Jara Quezada.
Prevalencia de osteoporosis en pacientes mexicanos con esclerodermia.
Rev Mex Reumatol, 17 (2002), pp. 85
[63.]
P.D. Sampaio-Barros, L. Costa-Paiva, S. Filardi, Z. Sachetto, A.M. Samara, J.F. Marques-Neto.
Prognostic factors of low bone mineral density in systemic sclerosis.
Clin Exp Rheumatol, 23 (2005), pp. 180-184
[64.]
H.C. Da Silva, V.L. Szejnfeld, L.S. Assis, E.I. Sato.
Study of bone density in systemic scleroderma.
Rev Assoc Med Bras, 43 (1997), pp. 40-46
[65.]
D. Eyre.
New biomarkers of bone resorption.
J Clin Endocrinol Metab, 74 (1992),
[66.]
G. La Montagna, A. Baruffo, S. Abbadesa, L. Maja, R. Tirri.
Evidence for bone resorption in systemic sclerosis.
J Rheumatol, 22 (1995), pp. 797-799
[67.]
R. Istok, L. Czirjak, J. Lukac, M. Stancikova, J. Rovensky.
Increased urinary pyridinoline cross-link compound of collagen in patients with systemic sclerosis and Raynaud’s phenomenon.
Rheumatology (Oxford), 40 (2001), pp. 140-146
[68.]
B. Shea, G. Wells, A. Cranney, N. Zytaruk, V. Robinson, L. Griffith, et al.
Osteoporosis methodology group and the osteoporosis research advisory group. Meta-analysis of therapy for postmenopausal osteoporosis VII: meta-analysis of calcium supplementation for the prevention for postmenopausal osteoporosis.
Endocrinol Rev, 23 (2002), pp. 552-559
[69.]
American College of Rheumatology Ad Hoc Committee on glucocorticoid- induced osteoporosis: Recommendations for the prevention and treatment of glucocorticoids-induced osteoporosis: 2001 update. Arthritis Rheum. 2001;44:1496-503.
[70.]
S.L. Morgan.
Calcium and vitamin D in osteoporosis.
Rheum Dis Clin North Am, 27 (2001), pp. 101-130
[71.]
J.E. Rossouw, G.L. Anderson, R.L. Prentice, A.Z. LaCroix, C. Kooperberg, M.L. Stefanick, et al.
Writing group for the Women’s Health Initiative Investigators. Risks and benefits of estrogens plus progestin in healthy postmenopausal women: principal results from Women’s Health Initiative randomized controlled trial.
JAMA, 288 (2002), pp. 321-333
[72.]
J.C. Gallagher.
Role of estrogens in the management of postmenopausal bone loss.
Rheum Dis Clin North Am, 27 (2001), pp. 143-162
[73.]
E. Barret-Connor, D. Grady, A. Sashegyi, P.W. Anderson, D.A. Cox, K. Hoszowski, et al.
MORE Investigators (Multiple outcomes of raloxifene evaluation): Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple outcomes of raloxifene evaluation) randomized trial.
JAMA, 287 (2002), pp. 847-857
[74.]
E.G. Lufkin, M. Wong, C. Deal.
The role of selective estrogen receptor modulators in the prevention and treatment of osteoporosis.
Rheum Dis Clin North Am, 27 (2001), pp. 163-185
[75.]
N.B. Watts.
Treatment of osteoporosis with bisphosphonates.
Rheum Dis Clin North Am, 27 (2001), pp. 197-214
[76.]
W.F. Lems, N.A. Hamdy, J.C. Netelenbos.
Teriparatide: an anabolic drug for the treatment of patients with osteoporosis.
Ned Tijdschr Geneeskd, 150 (2006), pp. 132-137
Copyright © 2006. Elsevier España S.L. Barcelona
Descargar PDF
Idiomas
Reumatología Clínica
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?