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VİTİLİGOLU HASTALARDA HİPOTALAMO-HİPOFİZER-ADRENAL AKSIN VE HASTALIĞIN TUTULUMU İLE SÜRESİ ARASINDAKİ İLİŞKİNİN DEĞERLENDİRİLMESİ

Yıl 2010, Cilt: 1 Sayı: 1, 15 - 22, 03.03.2015

Öz

Amaç: Vitiligo, herhangi bir yaşta ortaya çıkabilen, değişik büyüklükte ve sayıda, iyi sınırlı, süt beyazı renkte yamalar şeklinde görülen, melanosit yıkımı ile karakterize kazanılmış, ilerleyici, deri ve saç folikülünü tutan bir hastalıktır. Hastalığın etyopatogenezi hakkında çok şey bilinmese de hastalığa yönelik birçok hipotezler öne sürülmüştür. En önemli nedenlerinden biri otoimmünitedir. Bu hipotezi destekleyen en önemli verilerden biri de vitiligonun bazı otoimmün ve endokrin hastalıklarla (otoimmün poliendokrin sendromlarda olduğu gibi) birlikte görülmesidir. Adrenal yetmezlik de etyolojisinde çoğunlukla otoimmünitenin rol oynadığı bir hastalıktır. Adrenal yetmezliğin tanısında bu aksı değerlendiren çeşitli testler kullanılır. Serum bazal kortizol düzeyi tayini bunlardan biridir. Amacımız vitiligolu hastalarda serum bazal kortizol tayini ile hipotalamo- hipofizer- adrenal aksı (HPA) incelemektir.

Gereç ve Yöntem: Çalışmaya, Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesine 2008–2009 yılları arasında başvuran ve vitiligo tanısı alan 27 hasta (11 erkek, 16 kadın) alındı. Hastalıkla ilgili demografik veriler, klinik ve laboratuar parametreleri incelendi.

Bulgular ve Sonuç: Vitiligolu hastalarda yapılan analizler sonucunda serum bazal kortizol düzeyleri ile bu hastalığın tutulum şekli (jeneralize, fokal) ve süresi arasında anlamlı bir ilişkinin olmadığı tespit edildi. Bu bulgular, vitiligolu hastalarda HPA aksı değerlendirmede serum bazal kortizol düzeylerinin özellikle subklinik adrenal yetmezliği teşhis etmede yetersiz olduğunu ve ileri testlere gereksinim duyulduğunu göstermektedir. Bu araştırma, bilgilerimize göre literatürdeki vitiligolu hastalarda HPA aksı inceleyen ender çalışmalardan birisidir.


Kaynakça

  • 1. Orth DN, Kovacs WJ. The adrenal cortex. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR (eds), Williams Textbook of Endocrinology. 9th Edition W.B Saunders Company Philadelphia 1998; 517–520.
  • 2. Aron DC, Findling JW, Tyreel B. Hypothalamus and pituitary. In: Gardner DG, Shoback D (eds), Greenspan’s Basic and Clinical Endocrinology. 8th Edition United States 2007; 113–114.
  • 3. Canda MS. Temel Patoloji II. Endokrin (2. baskı) SKSD yayın No 5, Sıvas: Dilek Basımevi, 1988.
  • 4. Güvener N. Adrenal Korteksin Hipofonksiyonu. Türkiye Klinikleri J Int Med Sci 2005; 30–38.
  • 5. Akarsu E, Atmaca H, Balcı MK, Bolu E, Çolak R, Emral R, Ertürk E, Keleútimur F, øzol AN, Özıúık G, Tanrıverdi F, Tarkun ø, Ünlühizarcı K. Hipotalamo- hipofizer- adrenal aks klavuzu. Türkiye Endokrin ve Metabolizma Derne÷i 2009.
  • 6. Dökmetaú HS, Korkmaz S. Adrenokortikotropik hormon ve hastalıkları. Türkiye Klinikleri J Int Med Sci 2006; 37–44.
  • 7. Betterle C, Zanchetta R. Update on polyendocrine syndromes (APS). Acta Biomedica 2003; 9–33.
  • 8. Denli Y, Acar MA, Maraklı Sönmezo÷lu S, Yücel A. Vitiligo. Tüzün Y, Gürer MA, Serdaro÷lu S, O÷uz O, Aksungur V (editörler), Dermatoloji. 3. Baskı. Nobel Tıp Kitapevi østanbul 2008; 1465–1475.
  • 9. Bolognia JL, Lorizzo JL, Rapini RP. Dermatology. 2th Edition. Mosby, London, 2008; 913–919.
  • 10. Le Poole C, Boissy RE. Vitiligo. Semin Cutan Med Surg.1997; 3–14.
  • 11. Sehgal VN, Srivastava G. Vitiligo: compendium of clinico-epidemiological features. Dermatol Venereol Leprol. 2007; 73–75.
  • 12. Braun Falco O, Plewig G, Wolff HH, Burgdorf W. Disorders of depigmentation. Dermatology 2 th Edition Springer- Verlag Berlin. 2000; 1033– 1037.
  • 13. Jin Y, Mailloux C.M, Gowan K, Riccardi SL, La Berge G, Bennet DC, Fain PR, Spritz AR. NAPL-I in vitiligo associated autoimmun disorders. N Engl J Med. 2007; 1216–1225.
  • 14. Birlea SA, Fain P.R, Spritz RA. A Romanian population isolate with high frequency of vitiligo and associated autoimmune diseases. Arch Dermatol 2008; 310–316.
  • 15. Tanioka M, Yamamato Y, Katoh M, Takahashi K, Miyachi Y. Vitiligo vulgaris and autoimmune disease in Japan. Dermatology. 2009; 43–45.
  • 16. Nancy AL, Yehuda S. Prediction and prevention of autoimmune skin disorders. Arch Dermatol Res 2009; 57–64.
  • 17. Rashtak S, Pittelkow M. Dermatologic immunity. Curr Dir Autoimmun. 2008; 344–358.
  • 18. Spritz RA. The genetics of generalized vitiligo and associated autoimmune diseases. Pigment Cell Res. 2007; 271–278.
  • 19. Sedighe M, Gholamhossein G. Thyroid disfunction and thyroid antibodies in Iranian patients with vitiligo. Indian J Dermatol. 2008; 8–10.
  • 20. Dave S, D’souza M, Thapp DM, Reddy KS, Bobby Z. High frequency of thyroid dysfunction in Indian patients with vitiligo. Indian J Dermatol. 2003; 68–72.
  • 21. Vanderpump, MP, Tunbridge, WM. The epidemiology of thyroid diseases. In: Braverman, LE, Utiger RD (eds), The Thyroid: A Fundamental and Clinical Text. 8th Edition Lippincott Williams and Wilkins, Philadelphia, 2000; 487–473.
  • 22. Unlühizarci K, Bayram F, Güven M, Kula M, Colak R, Keleútimur F. Cortisol responses to low (1 microg) and standard (250 microg) dose ACTH stimulation tests in patients with primary hypothyroidism. Clin Edocrinol. 2001;700–702.
  • 23. Mishra SK, Gupta N, Goswami R. Plasma adrenocorticotropin (ACTH) values and cortisol response to 250 and 1ȝg ACTH stimulation in patients with hyperthyroidism before and after carbimazole therapy: case-control comparative study. J Clin Endocrinol Metab. 2007; 1693–1696.
  • 24. Demir H, Keleútimur F, Tunç M, Kirnap M, Özo÷ul Y. Hypothalamo-pituitary-adrenal axis and growth hormone axis in patients with rheumatoid arthritis. Scand J Rheumatol. 1999; 41–46.
  • 25. Demir H, Tanriverdi F, Ozo÷ul N, Caliú M, Kirnap M, Durak AC, Keleútimur F. Evaluation of the hypothalamic-pituitary-adrenal axis in untreated patients with polymyalgia rheumatica and healthy controls. Scand J Rheumatol. 2006; 217–223.
  • 26. Tsatsoulis A, Johnson EO, Kalogera CH, Seferiadis K and Tsolas O. The effect of thyrotoxicosis on adrenocortical reserve. European J Endocrinol. 2000; 231–235.
  • 27. Orth DN, Kovacs WJ. The adrenal cortex. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR. Williams Textbook of Endocrinology 9th Edition W.B Saunders Company Philadephia 1998; 549–559.
  • 28. Keleútimur F. The endocrinology of adrenal tuberculosis: the effects of tuberculosis on the hypothalamo-pituitary-adrenal axis and adrenocortical function. J Endocrinol Invest. 2004; 380–386.

EVALUATION OF HYPOTHALAMIC- PITUITARY-ADRENAL AXIS IN PATIENTS WITH VITILIGO AND ASSOCIATION BETWEEN THE INVOLVEMENT AND DURATION OF THE DISEASE

Yıl 2010, Cilt: 1 Sayı: 1, 15 - 22, 03.03.2015

Öz

Objective: Vitiligo is a disease which can be occurred at any age with various size and number, well-circumscribed, milk-white in
color as seen in patches, characterized acquired by destruction of melanocytes, progressive, keeps the skin and hair follicle.
Although a lot about the etiopathogenesis of diseases are unknown, many theses have been suggested for the disease. One of the
most important etiologies is autoimmunity. One of the most important data which supports this hypothesis is; vitiligo is seen with
some autoimmune and endocrine diseases together (as in autoimmune polyendocrine syndromes). Adrenal insufficiency is also a
disease which mainly plays a role in the etiology of autoimmunity and can bring vital risk and lead to crises if can not be diagnosed.
Functions of the adrenal gland is controlled by neuroendocrine physiological system which known as the hypothalamo pituitary
adrenal axis. Our aim was to investigate the hypothalamo-pituitary-adrenal axis of patients with vitiligo by measuring basal serum
cortisol level assays.
Materials & Methods: For this purpose, patients who were admitted to the outpatient clinic and 27 of whom with diagnosis of vitiligo
(11 men, 16 women) have been included in the current study. Diseases related to demographic data, clinical and laboratory
parameters were analyzed.
Results and Conclusion: As a result of done analysis on patients with vitiligo, a significant relationship between basal serum
cortisol levels and form of this disease involvement (generalized, focal) and the time period is not been observed. These findings in
patients with vitiligo, in the assessment of HPA axis, basal serum cortisol levels especially in diagnosing subclinical adrenal
insufficiency is inadequate and shows that further tests were required to indicate. According to our knowledge, this study is one the
few one in literature which examines the HPA axis on vitiligo patients.  

Kaynakça

  • 1. Orth DN, Kovacs WJ. The adrenal cortex. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR (eds), Williams Textbook of Endocrinology. 9th Edition W.B Saunders Company Philadelphia 1998; 517–520.
  • 2. Aron DC, Findling JW, Tyreel B. Hypothalamus and pituitary. In: Gardner DG, Shoback D (eds), Greenspan’s Basic and Clinical Endocrinology. 8th Edition United States 2007; 113–114.
  • 3. Canda MS. Temel Patoloji II. Endokrin (2. baskı) SKSD yayın No 5, Sıvas: Dilek Basımevi, 1988.
  • 4. Güvener N. Adrenal Korteksin Hipofonksiyonu. Türkiye Klinikleri J Int Med Sci 2005; 30–38.
  • 5. Akarsu E, Atmaca H, Balcı MK, Bolu E, Çolak R, Emral R, Ertürk E, Keleútimur F, øzol AN, Özıúık G, Tanrıverdi F, Tarkun ø, Ünlühizarcı K. Hipotalamo- hipofizer- adrenal aks klavuzu. Türkiye Endokrin ve Metabolizma Derne÷i 2009.
  • 6. Dökmetaú HS, Korkmaz S. Adrenokortikotropik hormon ve hastalıkları. Türkiye Klinikleri J Int Med Sci 2006; 37–44.
  • 7. Betterle C, Zanchetta R. Update on polyendocrine syndromes (APS). Acta Biomedica 2003; 9–33.
  • 8. Denli Y, Acar MA, Maraklı Sönmezo÷lu S, Yücel A. Vitiligo. Tüzün Y, Gürer MA, Serdaro÷lu S, O÷uz O, Aksungur V (editörler), Dermatoloji. 3. Baskı. Nobel Tıp Kitapevi østanbul 2008; 1465–1475.
  • 9. Bolognia JL, Lorizzo JL, Rapini RP. Dermatology. 2th Edition. Mosby, London, 2008; 913–919.
  • 10. Le Poole C, Boissy RE. Vitiligo. Semin Cutan Med Surg.1997; 3–14.
  • 11. Sehgal VN, Srivastava G. Vitiligo: compendium of clinico-epidemiological features. Dermatol Venereol Leprol. 2007; 73–75.
  • 12. Braun Falco O, Plewig G, Wolff HH, Burgdorf W. Disorders of depigmentation. Dermatology 2 th Edition Springer- Verlag Berlin. 2000; 1033– 1037.
  • 13. Jin Y, Mailloux C.M, Gowan K, Riccardi SL, La Berge G, Bennet DC, Fain PR, Spritz AR. NAPL-I in vitiligo associated autoimmun disorders. N Engl J Med. 2007; 1216–1225.
  • 14. Birlea SA, Fain P.R, Spritz RA. A Romanian population isolate with high frequency of vitiligo and associated autoimmune diseases. Arch Dermatol 2008; 310–316.
  • 15. Tanioka M, Yamamato Y, Katoh M, Takahashi K, Miyachi Y. Vitiligo vulgaris and autoimmune disease in Japan. Dermatology. 2009; 43–45.
  • 16. Nancy AL, Yehuda S. Prediction and prevention of autoimmune skin disorders. Arch Dermatol Res 2009; 57–64.
  • 17. Rashtak S, Pittelkow M. Dermatologic immunity. Curr Dir Autoimmun. 2008; 344–358.
  • 18. Spritz RA. The genetics of generalized vitiligo and associated autoimmune diseases. Pigment Cell Res. 2007; 271–278.
  • 19. Sedighe M, Gholamhossein G. Thyroid disfunction and thyroid antibodies in Iranian patients with vitiligo. Indian J Dermatol. 2008; 8–10.
  • 20. Dave S, D’souza M, Thapp DM, Reddy KS, Bobby Z. High frequency of thyroid dysfunction in Indian patients with vitiligo. Indian J Dermatol. 2003; 68–72.
  • 21. Vanderpump, MP, Tunbridge, WM. The epidemiology of thyroid diseases. In: Braverman, LE, Utiger RD (eds), The Thyroid: A Fundamental and Clinical Text. 8th Edition Lippincott Williams and Wilkins, Philadelphia, 2000; 487–473.
  • 22. Unlühizarci K, Bayram F, Güven M, Kula M, Colak R, Keleútimur F. Cortisol responses to low (1 microg) and standard (250 microg) dose ACTH stimulation tests in patients with primary hypothyroidism. Clin Edocrinol. 2001;700–702.
  • 23. Mishra SK, Gupta N, Goswami R. Plasma adrenocorticotropin (ACTH) values and cortisol response to 250 and 1ȝg ACTH stimulation in patients with hyperthyroidism before and after carbimazole therapy: case-control comparative study. J Clin Endocrinol Metab. 2007; 1693–1696.
  • 24. Demir H, Keleútimur F, Tunç M, Kirnap M, Özo÷ul Y. Hypothalamo-pituitary-adrenal axis and growth hormone axis in patients with rheumatoid arthritis. Scand J Rheumatol. 1999; 41–46.
  • 25. Demir H, Tanriverdi F, Ozo÷ul N, Caliú M, Kirnap M, Durak AC, Keleútimur F. Evaluation of the hypothalamic-pituitary-adrenal axis in untreated patients with polymyalgia rheumatica and healthy controls. Scand J Rheumatol. 2006; 217–223.
  • 26. Tsatsoulis A, Johnson EO, Kalogera CH, Seferiadis K and Tsolas O. The effect of thyrotoxicosis on adrenocortical reserve. European J Endocrinol. 2000; 231–235.
  • 27. Orth DN, Kovacs WJ. The adrenal cortex. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR. Williams Textbook of Endocrinology 9th Edition W.B Saunders Company Philadephia 1998; 549–559.
  • 28. Keleútimur F. The endocrinology of adrenal tuberculosis: the effects of tuberculosis on the hypothalamo-pituitary-adrenal axis and adrenocortical function. J Endocrinol Invest. 2004; 380–386.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Cumali Gökçe Bu kişi benim

Sema Asilyörük Bu kişi benim

Gamze Serarslan Bu kişi benim

İhsan Üstün Bu kişi benim

Murat Çelik Bu kişi benim

Nigar Yılmaz Bu kişi benim

Edip Uçar Bu kişi benim

Mehmet Demir Bu kişi benim

Hasan Kaya Bu kişi benim

Şerefettin Canda Bu kişi benim

Yayımlanma Tarihi 3 Mart 2015
Gönderilme Tarihi 2 Mart 2015
Yayımlandığı Sayı Yıl 2010 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Gökçe C, Asilyörük S, Serarslan G, Üstün İ, Çelik M, Yılmaz N, Uçar E, Demir M, Kaya H, Canda Ş. VİTİLİGOLU HASTALARDA HİPOTALAMO-HİPOFİZER-ADRENAL AKSIN VE HASTALIĞIN TUTULUMU İLE SÜRESİ ARASINDAKİ İLİŞKİNİN DEĞERLENDİRİLMESİ. mkutfd. 2015;1(1):15-22.