Autoimmune polyendocrine syndromes associated with autoimmune rheumatic diseases

Jankowska, Katarzyna; Dudek, Piotr; Stasiek, Małgorzata; Suchta, Katarzyna

doi:10.5114/reum/170266

Cited by 3 publications

(2 citation statements)

References 93 publications

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“…Type 3 stands firstly for not involving adrenal glands, but for having the combination of an autoimmune thyroid disease with another entity such as type 1 diabetes (type 3A), chronic atrophic gastritis, and/or pernicious anemia (type 3B) or vitiligo, alopecia, and myasthenia gravis (type 3C). Type 4 introduces other associations than the mentioned types [ 130 , 131 , 132 ].…”

Section: Discussionmentioning

confidence: 99%

Endocrine Petrified Ear: Associated Endocrine Conditions in Auricular Calcification/Ossification (A Sample-Focused Analysis)

Valea,

Nistor,

Ciobica

et al. 2024

Diagnostics

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Petrified ear (PE), an exceptional entity, stands for the calcification ± ossification of auricular cartilage (CAC/OAC); its pathogenic traits are still an open matter. Endocrine panel represents one of the most important; yet, no standard protocol of assessments is available. Our objective was to highlight most recent PE data and associated endocrine (versus non-endocrine) ailments in terms of presentation, imagery tools, hormonal assessments, biopsy, outcome, pathogenic features. This was a comprehensive review via PubMed search (January 2000–March 2024). A total of 75 PE subjects included: 46 case reports/series (N = 49) and two imagery-based retrospective studies (N = 26) with CAC/OAC prevalence of 7–23% (N = 251) amid routine head/temporal bone CT scans. Endocrine PE (EPE): N = 23, male/female ratio = 10.5; average age = 56.78, ranges: 22–79; non-EPE cohort: N = 26; male/female ratio = 1.88, mean age = 49.44; ranges: 18–75 (+a single pediatric case).The longest post-diagnosis follow-up was of 6–7 years. The diagnosis of PE and endocrine anomalies was synchronous or not (time gap of 10–20 years). A novel case in point (calcified EPE amid autoimmune poly-endocrine syndrome type 2 with a 10-year post-diagnosis documented follow-up) was introduced. We re-analyzed EPE and re-classified another five subjects as such. Hence, the final EPE cohort (N = 50) showed: adrenal insufficiency was the most frequent endocrine condition (36%) followed by hypopituitarism (22%) and hypothyroidism (18%); 39% of the patients with adrenal failure had Addison’s disease; primary type represented 72% of all cases with hypothyroidism; an endocrine autoimmune (any type) component was diagnosed in 18%. We propose the term of “endocrine petrified ear” and a workflow algorithm to assess the potential hormonal/metabolic background in PE.

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Section: Discussionmentioning

confidence: 99%

Endocrine Petrified Ear: Associated Endocrine Conditions in Auricular Calcification/Ossification (A Sample-Focused Analysis)

Valea,

Nistor,

Ciobica

et al. 2024

Diagnostics

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“…In APS-2, Hashimoto's thyroiditis coexists with Addison's disease, type I diabetes, hypogonadism, hypoparathyroidism, or pituitary insufficiency. In APS-3, chronic lymphocytic thyroiditis may occur with rheumatoid arthritis, lupus, Sjögren's syndrome, or type I diabetes [21].…”

Section: Other Autoimmune Comorbiditiesmentioning

confidence: 99%

The Role of the Immune System in the Course of Hashimoto’s Thyroiditis: The Current State of Knowledge

Wrońska,

Hałasa,

Szczuko

2024

IJMS

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The process of thyroid autoimmunization develops against the background of genetic predispositions associated with class II human leukocyte antigens (HLA-DR), as well as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), protein tyrosine phosphatase non-receptor type 22 (PTPN22), and forkhead transcription box protein P3 (FOXP3). Environmental factors, such as vitamin D deficiency, Zn, Se, and Mg, as well as infections, chronic stress, pregnancy, smoking, alcohol, medications, intestinal dysbiosis, and malnutrition, also play an important role. The first stage of autoimmunization involves the accumulation of macrophages and dendritic cells, as well as plasma cells. In the second stage, the mutual interactions of individual cells in the immune system lead to a decrease in the level of CD8+ in favor of CD4+, which intensifies the synthesis of T lymphocyte derivatives, especially Th1, Th17, Tfh, and Tc, reducing the level of Treg. Consequently, the number of the anti-inflammatory cytokines IL10 and IL2 decreases, and the synthesis of the pro-inflammatory cytokines IL-2, Il-12, Il-17, IL-21, IL-22, IFN-γ, and TNF-α increases. The latter two especially trigger the pyroptosis process involving the inflammasome. Activation of the inflammasome by IL-β and IL-18 produced by macrophages is one of the mechanisms of pyroptosis in the course of Hashimoto’s thyroiditis, involving Gram-negative bacteria and NLRC4. In the next step, the apoptosis of thyroid cells is initiated by the intensification of perforin, granzyme, and proteoglycan synthesis by Tc and NK cells. The current findings raise many possibilities regarding interventions related to the inhibition of pro-inflammatory cytokines and the stimulation of anti-inflammatory cytokines produced by both T and B lymphocytes. Furthermore, since there is currently no effective method for treating thyroid autoimmunity, a summary of the review may provide answers regarding the treatment of not only Hashimoto’s thyroiditis, but also other autoimmune diseases associated with autoimmunity.

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Rheumatic Disorders and Autoimmune Thyroid Disease. A Common Co-occurrence With an Unusual Presentation- A Case Report

Manzoor,

Ali,

Masood

et al. 2024

Preprint

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Introduction Graves’ disease (GD) and systemic lupus erythematosus (SLE) are two autoimmune disorders well known for their co-existence. Shared genetic susceptibility loci are being increasingly identified, confirming the causal bidirectional association between the two. Case Presentation Our case involves a young woman who presented with chronic symptoms of hyperthyroidism along with anemia, goitre, respiratory distress, and a recent onset of rheumatism. Diagnostic investigations fulfilled the criteria of GD along with SLE and Sjogren’s overlap. Pulmonary arterial hypertension (PAH) was detected via echocardiography, likely indicating the complex interplay between SLE and GD. Significant fetal and embryonic mortality raised the suspicion of anti-phospholipid syndrome, leading to the detection of anti-phospholipid antibodies. The likelihood of adrenal insufficiency and Autoimmune Polyglandular syndrome type 2 was also addressed. The patient was managed with anti-thyroid medications, steroids, and PAH-specific therapy. Our case is unique, as it involves multiple autoimmune disorders of rheumatic and endocrine origin in the same patient. The uniqueness also lies in the temporal sequence of the disorders, with GD being antecedent to SLE, contrary to what the literature suggests. Conclusion Although the patient tragically died, the goal here was to reinforce the idea that autoimmune disorders are complex, revealing themselves in various forms. Scouting for comorbidities and adapting a holistic treatment approach is prudent when dealing with these ailments. The social and financial dilemmas leading to noncompliance with treatment and its detrimental effects are also highlighted.

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Autoimmune polyendocrine syndromes associated with autoimmune rheumatic diseases

Cited by 3 publications

References 93 publications

Endocrine Petrified Ear: Associated Endocrine Conditions in Auricular Calcification/Ossification (A Sample-Focused Analysis)

Endocrine Petrified Ear: Associated Endocrine Conditions in Auricular Calcification/Ossification (A Sample-Focused Analysis)

The Role of the Immune System in the Course of Hashimoto’s Thyroiditis: The Current State of Knowledge

Rheumatic Disorders and Autoimmune Thyroid Disease. A Common Co-occurrence With an Unusual Presentation- A Case Report

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