Treatment of autoimmune premature ovarian failure

Hum Reprod. 1999 Jul;14(7):1777-82. doi: 10.1093/humrep/14.7.1777.

Abstract

There is no known immunosuppressive therapy for autoimmune premature ovarian failure that has been proven safe and effective by prospective randomized placebo-controlled study. Nevertheless, immunosuppression using corticosteroids has been used on an empirical basis for this condition. Here we present two cases of young women with premature ovarian failure who were treated with glucocorticoids in the hopes of restoring fertility. The first case illustrates the potential benefit of such therapy, and the second case illustrates a potential risk. The first patient with histologically proven autoimmune oophoritis was treated with alternate day glucocorticoid treatment. She had return of menstrual bleeding six times and ovulatory progesterone concentrations four times over a 16 week period. The second patient with presumed but unconfirmed autoimmune ovarian failure was referred to us after having been treated with a 9 month course of corticosteroids. During that treatment her menses did not resume. The corticosteroid treatment was complicated by iatrogenic Cushing syndrome and osteonecrosis of the knee. Identifying patients with autoimmune premature ovarian failure presents the opportunity to restore ovarian function by treating these patients with the proper immune modulation therapy. On the other hand, potent immune modulation therapy can have major complications. Corticosteroid therapy for autoimmune premature ovarian failure should be limited to use in placebo-controlled trials designed to evaluate the safety and efficacy of such treatment.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Autoimmune Diseases / drug therapy*
  • Autoimmune Diseases / pathology
  • Cushing Syndrome / chemically induced
  • Dexamethasone / adverse effects
  • Dexamethasone / therapeutic use
  • Female
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Iatrogenic Disease
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Knee
  • Oophoritis / drug therapy
  • Oophoritis / pathology
  • Oophoritis / physiopathology
  • Osteonecrosis / chemically induced
  • Osteonecrosis / pathology
  • Prednisone / therapeutic use
  • Primary Ovarian Insufficiency / drug therapy*
  • Primary Ovarian Insufficiency / pathology
  • Primary Ovarian Insufficiency / physiopathology

Substances

  • Glucocorticoids
  • Immunosuppressive Agents
  • Dexamethasone
  • Prednisone