Abstract: Are Women with Sjögren's Syndrome Androgen-Deficient?

Are Women with Sjögren's Syndrome Androgen-Deficient?

DAVID A. SULLIVAN, ALAIN BÉLANGER, JENNIFER M. CERMAK, RENÉ BÉRUBÉ, ATHENA S. PAPAS, ROSE M. SULLIVAN, HIROKO YAMAGAMI, M. REZA DANA, and FERNAND LABRIE

ABSTRACT.

Objective. We hypothesize that androgen deficiency is a critical etiologic factor in the pathogenesis of aqueous-deficient and evaporative dry eye in Sjögren's syndrome (SS). We investigated whether women with SS have a deficiency in total androgens. We also examined whether these patients have elevated serum concentrations of estrogens.

Methods. Blood was drawn from women with primary and secondary SS and age matched controls, and analyzed for steroid concentrations by gas and liquid chromatography-mass spectrometry.

Results. Our results show that women with SS are androgen-deficient. Concentrations of 5-androstene-3ß,17ß-diol (5-diol), dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), androsterone-glucuronide (ADT-G), and androstane-3a,17ß-diol-G (3a-diol-G) were all significantly reduced in SS sera relative to controls. In contrast, SS was not associated with significant alterations in the serum concentrations of testosterone, androstenedione, estrone, or 17ß-estradiol. These overall findings could not be attributed to the use of oral contraceptives or hormone replacement therapy, because the concentrations of 5-diol, DHEA, DHT, ADT-G and 3a-diol-G were also decreased in patients with SS compared to levels in control women who were not taking exogenous estrogens.

Conclusion. Our results show that women with SS are androgen-deficient. (J Rheumatol 2003; 30:2413-9)

Key Indexing Terms:

SJÖGREN'S SYNDROME
ANDROGENS
ESTROGENS
DRY EYE

From the Schepens Eye Research Institute, Harvard Medical School; Brigham and Women's Hospital; and Tufts University School of Dental Medicine, Boston, Massachusetts, USA; and Laboratory of Molecular Endocrinology, Centre Hospitalier Universitaire de Québec Research Center, Laval University, Quebec, Canada.

Supported by grants from Allergan, Inc., the Medical Research Council of Canada, and the Sjögren's Syndrome Foundation.

D.A. Sullivan, PhD, Schepens Eye Research Institute, Harvard Medical School; A. Bélanger, PhD, Centre Hospitalier Universitaire de Québec Research Center; J.M. Cermak, PhD, Schepens Eye Research Institute, Harvard Medical School, Brigham and Women's Hospital; R. Bérubé, MSc, Centre Hospitalier Universitaire de Québec Research Center; A.S. Papas, DMD, PhD, Tufts University School of Dental Medicine; R.M. Sullivan, RN, Schepens Eye Research Institute; H. Yamagami, MD, PhD, Schepens Eye Research Institute, Harvard Medical School; M.R. Dana, MD, MPH, Schepens Eye Research Institute, Harvard Medical School, Brigham and Women's Hospital; F. Labrie, MD, PhD, Centre Hospitalier Universitaire de Québec Research Center.

Address reprint requests to Dr. D.A. Sullivan, Schepens Eye Research Institute, 20 Staniford Street, Boston, MA 02114, USA. E-mail: sullivan@vision.eri.harvard.edu

Submitted November 14, 2002; revision accepted March 2, 2003.