Menstrual irregularities, fertility status, and ovarian function in female patients with leprosy in India.

BACKGROUND: Gonadal involvement in males in lepromatous leprosy is not uncommon, but there is a paucity of literature on the involvement of gonads in female patients with leprosy. This study was undertaken to determine if there is any menstrual dysfunction, alteration in fertility status and circulating luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and estradiol in female patients with paucibacillary (PB) and multibacillary (MB) leprosy. MATERIALS AND METHODS: In a cross-sectional study, 229 patients with leprosy (79 with PB leprosy and 150 with MB leprosy) and 100 age-matched non-leprosy controls were evaluated for menstrual function, fertility status, and circulating sex hormones. RESULTS: Twenty percent of patients with MB leprosy had menstrual irregularities post-dating the onset of leprosy in comparison to 6.3% patients with PB leprosy, and this difference was statistically significant (P < 0.001). However, the fertility profile of patients with PB leprosy was comparable to that of patients with MB leprosy (P > 0.05). A significantly higher number of patients with MB leprosy (9.3%) had elevation of circulating FSH, LH, and prolactin vis-à-vis patients with PB leprosy (1.3%), and this difference was statistically significant (P < 0.05). Similarly, the mean levels of LH, FSH, and prolactin were significantly elevated in patients with MB leprosy vis-à-vis patients with PB leprosy and controls (P < 0.05). CONCLUSIONS: Multibacillary leprosy may be associated with menstrual irregularities and elevation of gonadotropin hormones, indicating an ovarian dysfunction.

Pituitary-gonadal hormones and interleukin patterns in leprosy.

The functional status of pituitary-gonadal hormones and their relationship to the pattern of inflammatory cytokines in the lepromatous (LL/BL) and tuberculoid (TT/BT) poles of leprosy were investigated. Gonadotropins [luteinizing hormone (LH) and follicle-stimulating hormone (FSH)], interleukin (IL)-1beta, IL-6, tumour necrosis factor (TNF)-alpha and C-reactive protein (CRP) concentrations and erythrocyte sedimentation rate (ESR) were significantly higher in LL/BL leprosy patients than in controls and were not different from controls in TT/BT patients. LH and FSH were positively correlated with IL-1beta, IL-6 and TNF-alpha, and CRP concentrations and ESR. Testosterone plasma levels were significantly decreased in LL/BL patients and not different in TT/BT patients compared with controls. In addition, testosterone levels were inversely correlated with IL-6 and TNF-alpha. Prolactin plasma levels of both LL/BL and TT/BT patients were not different when compared with those of controls. There was a significant positive correlation between IL-6 and TNF-alpha plasma levels and ESR and CRP concentrations. IL-1beta was positively correlated with ESR but not with CRP. The significant correlations between gonadotropins and testosterone and cytokines in leprosy patients suggest that cytokines may have a direct influence at testicular level and may be of pathogenetic significance in leprosy and in other inflammatory states involving reproductive dysfunction.

Ovarian function in female patients with multibacillary leprosy.

Eighty six adult female patients with multibacillary leprosy were included to study the sex hormone profile LH, FSH, and prolactin, as well as their gynecological events like menstrual function and fertility status. A third of the patients gave a history of irregularity of periods. The mean levels of LH and FSH were significantly higher in patients with multibacilary leprosy vis-à-vis the controls. Of the 24 married women with irregularity of periods, 12 (50%) were infertile. Seven of these patients had elevated levels of FSH and LH, almost reaching castration levels.

Endocrine testicular functions in leprosy.

Pituitary testicular functions were evaluated in leprosy. Forty-three men with leprosy were studied by basal estimations of plasma LH, FSH, Prolactin, Testosterone, 17-beta estradiol, metoclopramide stimulated prolactin responses and hCG stimulated testosterone responses. Fifteen young healthy men with proven fertility were studied as control subjects. The hormone estimations were related to the histologic changes observed in the testicular biopsies of leprous hypogonadism. In lepromatous leprosy (n:18) the basal plasma gonadotropin levels were significantly increased (FSH 29.5 +/- 2.3 mlU/ml; LH 21.5 +/- 1.9 mlU/ml, mean +/- SE). The plasma gonadotropins were in the normal range in tuberculoid leprosy. In borderline leprosy, the basal mean plasma FSH was normal, whereas LH levels were significantly increased (22.5 +/- 1.2 mlU/ml). The basal plasma testosterone levels were significantly decreased in lepromatous leprosy (1.6 +/- 0.12 ng/ml), tuberculoid leprosy (4.2 +/- 1.7 ng/ml) and borderline leprosy (1.8 +/- 0.18 ng/ml). The basal plasma 17-beta estradiol levels were significantly elevated in all the three types of leprosy. The basal plasma prolactin levels in plasma were significantly increased in lepromatous and tuberculoid leprosy. During hCG stimulation tests, the peak plasma testosterone responses were significantly reduced in both lepromatous leprosy and tuberculoid leprosy subjects. The blunted testosterone responses during hCG stimulation tests in leprosy correlated with the high basal 17-beta estradiol levels (r = 0.58; P less than 0.05). These results strongly suggest that hypogonadism in leprosy results from primary testicular failure. The significant elevation of plasma 17-beta estradiol levels in lepromatous, tuberculoid and borderline leprosy could play a role in hypogonadism of leprosy.

Endocrine profile and seminal plasma composition in Hansen's disease.

Endocrine profile and seminal plasma composition in 45 patients with tuberculoid-type Hansen's disease are reported. There was marked reduction in sperm count and motility (p less than 0.01, p less than 0.01, respectively) with an increase in abnormal forms of spermatozoa (p less than 0.05). The levels of serum prolactin and oestradiol-17B were increased significantly (p less than 0.05, p less than 0.05, respectively) with a marked reduction in serum FSH, LH and testosterone (p less than 0.05, p less than 0.05, p less than 0.05, respectively). The possible significance of these findings may help further to understand male reproductive function in Hansen's disease.

Hormone profile in lepromatous leprosy. A preliminary study.

In a preliminary study, 11 male patients with lepromatous leprosy were evaluated with regard to endocrinopathy and hormonal status. Basal circulating hormone levels were estimated with a view to correlating the biochemical findings and clinical features. Thyroid hormones T3 and T4, Free Thyroxine Index (FTI), TSH, and cortisol were within normal limits, indicating that further study of these hormones would not be worthwhile. The finding of elevated levels of prolactin as well as the gonadotrophins LH and FSH, however, promises to yield more valuable information if studied in greater detail in a larger group of patients.