Premature Ovarian Failure: An Association with Autoimmune Diseases

Premature Ovarian Failure (POF) is the syndrome consisting of primary or secondary amenorrhea, hypergonadotropism and hypoestrogenemia in women below 40 years of age.It is diagnosed on the basis of two levels of serum FSH ≥40mIU/mL taken 6 weeks apart.It affects one in 10,000 women by age 20, one in 1,000 women by age 30 and one in 100 women by age 40 [1].Ovarian failure manifests itself between 30-39years in 82.5% cases [2].POF accounts for 5-10% cases of secondary amenorrhea [3,4] and 10-28% cases of primary amenorrhea [2].Most of the cases of POF are idiopathic, accounting for 60-80% of total cases [1,5,6].Other causes of POF include genetic, autoimmune, iatrogenic and those resulting from environmental insults.POF is reported to be associated with autoimmune diseases in 20-30% of cases.Most common are the thyroid disorders, which are seen in 30-40% of cases of POF [7-11].Adrenal autoimmunity is second most common autoimmune disease associated with POF [12,13].Diabetes mellitus is seen in 2.5% of the cases [12].Autoimmune Polyglandular Syndromes (APS) are a rare group of disorders characterized by autoimmune activity against more than one endocrine organ; non-endocrine organs can also be affected.APS type I is an autosomal recessive disorder, characterized by autoimmune dysfunction of parathyroid gland (hypocalcemeia) and adrenal gland (Addison's disease).POF is seen in 41-72% of patients with APS Type I [12,13].APS Type II is a more common disorder associated with Addison's disease, primary hypothyroididsm and Grave's disease.Primary hypogonadism is less common in this group.The prevalence of ovarian failure in APS-ll is 10-25% [13].Various toxins (smoking) and viruses (Mumps) have been implicated in the occurrence of POF [5,9,14].Iatrogenic causes include surgery, chemotherapy and radiotherapy, which account for a small proportion of cases.In the present study, patients presenting with idiopathic POF were screened for the presence of autoimmune disorders like thyroid and adrenal disease.