Muñoz, C; Isenberg, DA; (2019) Review of major endocrine abnormalities in patients with systemic lupus erythematosus. Clinical and Experimental Rheumatology (In press).

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Abstract

OBJECTIVES: Systemic lupus erythematosus is associated with an increased risk of developing an endocrine disease. These endocrinopathies can closely mimic SLE symptoms ranging from fatigue to renal involvement but the treatment is often very different. METHODS: A careful review of the PubMed and MEsH databases linking endocrine disease to SLE was performed. A retrospective analysis of the 708 SLE patient cohort at University College London Hospital (UCLH) has been completed. They have been followed for at least one year from 1978 to 2017. In our study, we report how often these endocrine diseases are identified in lupus patients compared to the general population and whether these patients with both diseases had a poorer prognosis. We have attempted to establish if the endocrine diseases develop before or after the lupus diagnosis. RESULTS: The literature search produced some conflicting results. 708 SLE patients were included in our study. We found 67 endocrine diseases in 55 different patients of our cohort. The most common endocrinopathy was hypothyroidism (5.22%) followed by type 2 diabetes mellitus (1.41%) and hyperthyroidism (1.41%). Other endocrine disorders also identified were type 1 diabetes mellitus (0.42%) and hyperparathyroidism (0.70%). In terms of mortality, lupus patients with concomitant endocrine disease had similar outcomes compared to those without endocrine disease (16.36% died vs. 15.16%). In general terms, these endocrine diseases were developed after the lupus diagnosis. We found that the 21.8% of our SLE plus endocrinopathy patients also have an increased risk of developing a second endocrine disease. CONCLUSIONS: We report concomitant endocrine disease in 7.76 % of our 708 SLE cohort followed, for almost 40 years, at UCLH. These patients have increased liability to develop a second endocrine disease, but overall there is no difference in terms of mortality between SLE patients with or without an endocrinopathy. It is important to capture endocrine diseases in SLE as the symptoms they cause may mimic SLE features, but require quite distinct treatment.

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