This Article Full Text Full Text (PDF) All Versions of this Article: 90/5/3069    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Welt, C. K. Articles by Hall, J. E. Search for Related Content PubMed PubMed Citation Articles by Welt, C. K. Articles by Hall, J. E. Related Collections Female Endocrinology

Selective Theca Cell Dysfunction in Autoimmune Oophoritis Results in Multifollicular Development, Decreased Estradiol, and Elevated Inhibin B Levels

Reproductive Endocrine Unit (C.K.W., A.E.T., K.A.M., J.E.H.), Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Internal Medicine (A.F.), University of Perugia, 06126 Perugia, Italy

Address all correspondence and requests for reprints to: Corrine K. Welt, M.D., Reproductive Endocrine, BHX 511, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114. E-mail: cwelt{at}partners.org.

We describe the clinical course of three women with presumptive autoimmune oophoritis who developed multiple follicles but very low to undetectable estradiol levels. Multiple follicles developed spontaneously in all subjects and during pulsatile GnRH treatment for ovulation induction in subject 1. The development of multiple dominant follicles was accompanied by LH levels in the postmenopausal range and FSH levels at the upper limit for premenopausal women. Serum inhibin B levels were elevated appropriately in the setting of multifollicular development, but estradiol levels remained low. Measurement of estradiol precursors demonstrated androstenedione and estrone levels below the 95th percentile in normal women. Adrenal cortical antibodies, and antibodies to 21-hydroxylase and P450 side chain cleavage enzymes were identified in all subjects. All subjects met the criteria for premature ovarian failure during follow-up. Subject 1 later developed adrenal failure, whereas subject 3 had adrenal failure at the time of the study.

These subjects elucidate the hormonal pattern in autoimmune oophoritis, before the full criteria for premature ovarian failure are met. The elevated inhibin A and B levels, which accompany the development of multiple small and dominant follicles in these women, suppress FSH relative to LH levels, virtually independent of estradiol. These data provide further evidence for an important role of inhibin B and inhibin A in the negative feedback control of FSH. In addition, the normal inhibin A and inhibin B production in the absence of estradiol precursors and estradiol provide insight into the selective dysfunction of the theca cells in autoimmune oophoritis.

This article has been cited by other articles:

				C. K. WELT Autoimmune Oophoritis in the Adolescent Ann. N.Y. Acad. Sci., June 1, 2008; 1135(1): 118 - 122. [Abstract] [Full Text] [PDF]

				R. W. REBAR Premature Ovarian "Failure" in the Adolescent Ann. N.Y. Acad. Sci., June 1, 2008; 1135(1): 138 - 145. [Abstract] [Full Text] [PDF]

				A. Tsigkou, S. Marzotti, L. Borges, A. Brozzetti, F. Reis, P. Candeloro, M. Luisa Bacosi, V. Bini, F. Petraglia, and A. Falorni High Serum Inhibin Concentration Discriminates Autoimmune Oophoritis from Other Forms of Primary Ovarian Insufficiency J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1263 - 1269. [Abstract] [Full Text] [PDF]