Kronik spontan ürtiker hastalarında endokrinolojik hastalıkların değerlendirilmesi / Evaluation of endocrinological diseases in chronic spontaneous urticaria patients

Abstract

Urticaria is a vascular reaction characterized by the formation of urtica plaques, angioedema or a combination of both, and edema of the superficial dermis. If urticaria lasts less than 6 weeks, it is called acute urticaria (AU), while conditions exceeding 6 weeks are considered within the chronic urticaria (CU) group. Although many studies have been done about the etiology of CU, the etiology still cannot be clarified in some patients. These patients are considered as chronic spontaneous urticaria (CSU). Endocrinological diseases are a series of diseases caused by hormones and/or organs affected by hormones. Although there are studies showing the relationship between autoimmune thyroid diseases and CSU in the literature, there is still no consensus due to this association. Evidence that CSU progresses with chronic inflammation has been increasing in recent years. As in other skin diseases with chronic inflammation, there are publications reporting an increased risk of metabolic syndrome in CSU. There are studies reporting that sex hormones have a small effect on symptom severity in the female patient population. The absence of a significant gender difference in the prevalence of CSU in childhood, female predominance between the ages of 20-64, and the disappearance of this difference after the age of 64 support the hypothesis that sex hormones contribute to the pathogenesis. In this study, we aimed to evaluate the incidence of accompanying endocrinological diseases in the CSU patient and control groups, the epidemiological characteristics of the patient and control groups, thyroid function tests, blood glucose levels, thyroid autoantibody levels and other endocrinological diseasas, if any. We also evaluated effects of menarche, menstrual periods, pregnancy, oral contraceptive (OCS)/hormone replacement therapy (HRT) usage and menopause on CSU symptom severity in female patients. In this study, 107 CSU patients have been included aged between 18 and 74 who applied to the Bezmialem Vakıf University Medical Faculty Dermatology outpatient clinic between January 2021 and June 2021, and 53 volunteers aged between 18 and 65 who did not have a known systemic disease as the control group, who matched with patient group in aspect of sex and age. Fasting serum glucose, TSH, free T4 (fT4), anti-thyroglobulin (Anti-TG) and anti-thyroid peroxidase (Anti-TPO) levels were compared in the patient and control groups. In addition, both groups were questioned in detail in terms of the presence of diseases involving other elements of the endocrine system (parathyroid, hypothalamus-pituitary-adrenal axis, gonads, pancreas). There was no statistically significant difference in TSH and fT4 levels in the patient and control groups. However, we think that routine follow-up is important since the low TSH level is proportionally higher in the CSU group. While there was no significant difference between the groups in terms of anti-TG, anti-TPO level was found to be significantly higher in the CSU group (p=0.014). While high Anti-TPO levels were detected in 19 of the individuals in the patient group, high levels of Anti-TPO were observed in only 2 patients in the control group. We think that thyroid function tests should be followed up frequently in patients with thyroid auto-antibody positivity, and it would be useful to question other autoimmune diseases with an increased incidence in CSU in this patient group. It is known that skin diseases with chronic inflammation are a risk factor for metabolic syndrome. Data on the increase in the level of systemic inflammation in CU are increasing day by day. We found the rate of DM to be significantly higher in our study (p=0.016). We think that chronic urticaria patients may carry one or more of the metabolic syndrome components despite their young age, and appropriate screening tests should be performed considering this situation. Although there were patients who stated that hormonal factors affect the severity of urticaria in our study, it is not possible to make a statistical interpretation. Randomized controlled studies examining the effects of natural hormonal factors and OCS/HRT use on CSU are needed in the literature.