Do Hormonal Disorders Contribute to the Pathology of Hereditary Angioedema?

Yıl 2022, Cilt: 4 Sayı: 4, 155 - 162, 29.10.2022

Gökhan Aytekin Hakan Ozer İsmail Baloğlu Fatih Çölkesen Eray Yıldız Şevket Arslan Ahmet Çalışkaner

https://doi.org/10.46310/tjim.1066357

Öz

Objective: Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by recurrent episodes of angioedema without urticaria or pruritus. In this study, we compared the levels of anabolic hormones, such as insulin, insulin-like growth factor, growth hormone, and thyroid hormones (thyroid-stimulating hormone [TSH], triiodothyronine [T3], and thyroxine [T4]), and the levels of hormones that are considered catabolic, such as adrenocorticotrophic hormone (ACTH) and cortisol, between HAE patients and controls. We also discuss the contribution of these hormones to the pathophysiology of HAE.

Methods: The study included 18 patients (9 diagnosed with HAE type 1 and 9 with HAE type 2) who were followed in the immunology and allergy clinic between January 2013 and January 2020. The control group comprised 28 age- and gender-matched subjects.

Results: The HAE type 1, HAE type 2, and control groups showed no significant differences in insulin, insulin-like growth factor, ACTH, cortisol, TSH, or T4 levels. The C-peptide and T3 levels were significantly different between the groups (p = 0.011 and p = 0.027, respectively) (Table 3). Post-hoc pairwise comparison revealed no significant difference in C-peptide level among the groups, but a significant difference in the T3 level was detected between HAE type 1 patients and controls (p = 0.029)

Conclusions: Although no significant differences were observed in other anabolic hormone levels between the controls and HAE patients, T3 levels were significantly lower in type 1 HAE patients. Close monitoring of low T3 levels is required, particularly in patients with type 1 HAE.

Anahtar Kelimeler

Hereditary angioedema, anabolic hormones, T3

Kaynakça

• Bork K, Meng G, Staubach P, Hardt J. Hereditary angioedema: new findings concerning symptoms, affected organs, and course. Am J Med. 2006 Mar;119(3):267-74. doi: 10.1016/j.amjmed.2005.09.064.
• Busse PJ, Christiansen SC. Hereditary angioedema. N Engl J Med. 2020 Mar 19;382(12):1136-48. doi: 10.1056/NEJMra1808012.
• Bork K, Frank J, Grundt B, Schlattmann P, Nussberger J, Kreuz W. Treatment of acute edema attacks in hereditary angioedema with a bradykinin receptor-2 antagonist (Icatibant). J Allergy Clin Immunol. 2007 Jun;119(6):1497-503. doi: 10.1016/j.jaci.2007.02.012.
• Maurer M, Magerl M, Ansotegui I, Aygören-Pürsün E, Betschel S, Bork K, Bowen T, Balle Boysen H, Farkas H, Grumach AS, Hide M, Katelaris C, Lockey R, Longhurst H, Lumry WR, Martinez-Saguer I, Moldovan D, Nast A, Pawankar R, Potter P, Riedl M, Ritchie B, Rosenwasser L, Sánchez-Borges M, Zhi Y, Zuraw B, Craig T. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2017 revision and update. Allergy. 2018 Aug;73(8):1575-96. doi: 10.1111/all.13384.
• Zuraw BL, Bernstein JA, Lang DM, Craig T, Dreyfus D, Hsieh F, Khan D, Sheikh J, Weldon D, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. A focused parameter update: hereditary angioedema, acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema. J Allergy Clin Immunol. 2013 Jun;131(6):1491-3. doi: 10.1016/j.jaci.2013.03.034.
• Zuraw BL, Busse PJ, White M, Jacobs J, Lumry W, Baker J, Craig T, Grant JA, Hurewitz D, Bielory L, Cartwright WE, Koleilat M, Ryan W, Schaefer O, Manning M, Patel P, Bernstein JA, Friedman RA, Wilkinson R, Tanner D, Kohler G, Gunther G, Levy R, McClellan J, Redhead J, Guss D, Heyman E, Blumenstein BA, Kalfus I, Frank MM. Nanofiltered C1 inhibitor concentrate for treatment of hereditary angioedema. N Engl J Med. 2010 Aug 5;363(6):513-22. doi: 10.1056/NEJMoa0805538.
• Banerji A, Busse P, Shennak M, Lumry W, Davis-Lorton M, Wedner HJ, Jacobs J, Baker J, Bernstein JA, Lockey R, Li HH, Craig T, Cicardi M, Riedl M, Al-Ghazawi A, Soo C, Iarrobino R, Sexton DJ, TenHoor C, Kenniston JA, Faucette R, Still JG, Kushner H, Mensah R, Stevens C, Biedenkapp JC, Chyung Y, Adelman B. Inhibiting plasma kallikrein for hereditary angioedema prophylaxis. N Engl J Med. 2017 Feb 23;376(8):717-28. doi: 10.1056/NEJMoa1605767.
• Frank MM. 8. Hereditary angioedema. J Allergy Clin Immunol. 2008 Feb;121(2 Suppl):S398-401; quiz S419. doi: 10.1016/j.jaci.2007.07.057.
• Herrmann G, Schneider L, Krieg T, Hunzelmann N, Scharffetter-Kochanek K. Efficacy of danazol treatment in a patient with the new variant of hereditary angio-oedema (HAE III). Br J Dermatol. 2004 Jan;150(1):157-8. doi: 10.1111/j.1365-2133.2004.05669.x.
• Veronez CL, Moreno AS, Constantino-Silva RN, Maia LSM, Ferriani MPL, Castro FFM, Valle SR, Nakamura VK, Cagini N, Gonçalves RF, Mansour E, Serpa FS, Coelho Dias GA, Piccirillo MA, Toledo E, de Souza Bernardes M, Cichon S, Stieber C, Arruda LK, Pesquero JB, Grumach AS. Hereditary angioedema with normal C1 inhibitor and F12 mutations in 42 Brazilian families. J Allergy Clin Immunol Pract. 2018 Jul-Aug;6(4):1209-16.e8. doi: 10.1016/j.jaip.2017.09.025.
• Gelfand JA, Sherins RJ, Alling DW, Frank MM. Treatment of hereditary angioedema with danazol. Reversal of clinical and biochemical abnormalities. N Engl J Med. 1976 Dec 23;295(26):1444-8. doi: 10.1056/NEJM197612232952602.
• Farkas H, Czaller I, Csuka D, Vas A, Valentin S, Varga L, Széplaki G, Jakab L, Füst G, Prohászka Z, Harmat G, Visy B, Karádi I. The effect of long-term danazol prophylaxis on liver function in hereditary angioedema-a longitudinal study. Eur J Clin Pharmacol. 2010 Apr;66(4):419-26. doi: 10.1007/s00228-009-0771-z.
• Lin KH, Lee HY, Shih CH, Yen CC, Chen SL, Yang RC, Wang CS. Plasma protein regulation by thyroid hormone. J Endocrinol. 2003 Dec;179(3):367-77. doi: 10.1677/joe.0.1790367.
• Potlukova E, Jiskra J, Freiberger T, Limanova Z, Zivorova D, Malickova K, Springer D, Grodecka L, Antosova M, Telicka Z, Pesickova SS, Trendelenburg M. The production of mannan-binding lectin is dependent upon thyroid hormones regardless of the genotype: a cohort study of 95 patients with autoimmune thyroid disorders. Clin Immunol. 2010 Jul;136(1):123-9. doi: 10.1016/j.clim.2010.02.015.
• Gompel A, Fain O, Boccon-Gibod I, Gobert D, Bouillet L. Exogenous hormones and hereditary angioedema. Int Immunopharmacol. 2020 Jan;78:106080. doi: 10.1016/j.intimp.2019.106080.
• Zhang B, Jiang Y, Yang Y, Peng F, Hu X. Correlation between serum thyroxine and complements in patients with multiple sclerosis and neuromyelitis optica. Neuro Endocrinol Lett. 2008 Apr;29(2):256-60.
• Karkhaneh M, Qorbani M, Ataie-Jafari A, Mohajeri-Tehrani MR, Asayesh H, Hosseini S. Association of thyroid hormones with resting energy expenditure and complement C3 in normal weight high body fat women. Thyroid Res. 2019 Oct 25;12:9. doi: 10.1186/s13044-019-0070-4.
• Czaller I, Csuka D, Zotter Z, Veszeli N, Takács E, Imreh É, Varga L, Farkas H. Thyroid hormones and complement parameters in hereditary angioedema with C1-inhibitor deficiency. Ann Allergy Asthma Immunol. 2016 Aug;117(2):175-9. doi: 10.1016/j.anai.2016.06.005.
• Erem C. Coagulation and fibrinolysis in thyroid dysfunction. Endocrine. 2009 Aug;36(1):110-8. doi: 10.1007/s12020-009-9185-z.
• Franchini M. Hemostatic changes in thyroid diseases: haemostasis and thrombosis. Hematology. 2006 Jun;11(3):203-8. doi: 10.1080/10245330600667591.
• Franchini M, Montagnana M, Manzato F, Vescovi PP. Thyroid dysfunction and hemostasis: an issue still unresolved. Semin Thromb Hemost. 2009 Apr;35(3):288-94. doi: 10.1055/s-0029-1222607.
• Fraser K, Robertson L. Chronic urticaria and autoimmunity. Skin Therapy Lett. 2013 Nov-Dec;18(7):5-9.
• Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, Guzman-Avilan RI, Canseco-Villarreal JI, Arias-Cruz A. Chronic urticaria and thyroid pathology. World Allergy Organ J. 2020 Mar 6;13(3):100101. doi: 10.1016/j.waojou.2020.100101.
• Kasumagic-Halilovic E, Beslic N, Ovcina-Kurtovic N. Thyroid autoimmunity in patients with chronic urticaria. Med Arch. 2017 Feb;71(1):29-31. doi: 10.5455/medarh.2017.71.29-31.
• Kolkhir P, Metz M, Altrichter S, Maurer M. Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: A systematic review. Allergy. 2017 Oct;72(10):1440-60. doi: 10.1111/all.13182.
• Farkas H, Csuka D, Gács J, Czaller I, Zotter Z, Füst G, Varga L, Gergely P. Lack of increased prevalence of immunoregulatory disorders in hereditary angioedema due to C1-inhibitor deficiency. Clin Immunol. 2011 Oct;141(1):58-66. doi: 10.1016/j.clim.2011.05.004.
• Muhlemann MF, Macrae KD, Smith AM, Beck P, Hine I, Hegde U, Milford-Ward A, Carter GD, Wise PH, Cream JJ. Hereditary angioedema and thyroid autoimmunity. J Clin Pathol. 1987 May;40(5):518-23. doi: 10.1136/jcp.40.5.518.
• Levy D, Craig T, Keith PK, Krishnarajah G, Beckerman R, Prusty S. Co-occurrence between C1 esterase inhibitor deficiency and autoimmune disease: a systematic literature review. Allergy Asthma Clin Immunol. 2020 May 27;16:41. doi: 10.1186/s13223-020-00437-x.
• Liu MJ, Shyur SD, Chuang HH, Yang PH. Hereditary angioedema and Graves’ disease: The first case report. J Formos Med Assoc. 2017 Oct;116(10):819-20. doi: 10.1016/j.jfma.2017.04.016.
• Bowen T, Cicardi M, Farkas H, Bork K, Longhurst HJ, Zuraw B, Aygoeren-Pürsün E, Craig T, Binkley K, Hebert J, Ritchie B, Bouillet L, Betschel S, Cogar D, Dean J, Devaraj R, Hamed A, Kamra P, Keith PK, Lacuesta G, Leith E, Lyons H, Mace S, Mako B, Neurath D, Poon MC, Rivard GE, Schellenberg R, Rowan D, Rowe A, Stark D, Sur S, Tsai E, Warrington R, Waserman S, Ameratunga R, Bernstein J, Björkander J, Brosz K, Brosz J, Bygum A, Caballero T, Frank M, Fust G, Harmat G, Kanani A, Kreuz W, Levi M, Li H, Martinez-Saguer I, Moldovan D, Nagy I, Nielsen EW, Nordenfelt P, Reshef A, Rusicke E, Smith-Foltz S, Späth P, Varga L, Xiang ZY. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol. 2010 Jul 28;6(1):24. doi: 10.1186/1710-1492-6-24.
• Bousfiha A, Jeddane L, Picard C, Al-Herz W, Ailal F, Chatila T, Cunningham-Rundles C, Etzioni A, Franco JL, Holland SM, Klein C, Morio T, Ochs HD, Oksenhendler E, Puck J, Torgerson TR, Casanova JL, Sullivan KE, Tangye SG. Human inborn errors of immunity: 2019 Update of the IUIS Phenotypical Classification. J Clin Immunol. 2020 Jan;40(1):66-81. doi: 10.1007/s10875-020-00758-x.