Jankowska Katarzyna, Dudek Piotr, Stasiek Małgorzata, Suchta Katarzyna
Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland.
Biological Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
Reumatologia. 2023;61(4):225-238. doi: 10.5114/reum/170266. Epub 2023 Aug 31.
Autoimmune polyendocrine syndromes (APSs), also called autoimmune polyglandular syndromes, are a group of autoimmune diseases characterized by the co-occurrence of dysfunctions of several (at least two) endocrine glands. They develop under the influence of environmental factors in genetically predisposed people. Autoimmune polyendocrine syndromes may accompany autoimmune rheumatic diseases and worsen their course - APS-2 and APS-3 are the most common. The APS-2 includes the coexistence of, e.g. Hashimoto's disease, celiac disease and rheumatoid arthritis (RA). In APS-3, rheumatic diseases such as RA, systemic lupus erythematosus, and Sjögren's syndrome may coexist with Hashimoto's disease, type 1 diabetes and hypogonadism or other endocrinopathies. Undiagnosed endocrine diseases may be the reason for the intensification of metabolic disorders observed in the course of rheumatic diseases, cause the ineffectiveness of rheumatological treatment and also increase the frequency of bone fractures due to osteoporosis, cardiovascular complications and even miscarriages when coexistent, e.g. Hashimoto's disease with hypothyroiditis, which increases the risk of pregnancy loss. It is important to be able to conduct an extensive interview, paying attention to the symptoms of possible endocrinopathy as well as the features of other autoimmune disorders in the physical examination (e.g. vitiligo or darkening of the skin in Addison's disease). Depending on the history and physical examination, screening for various APSs is advised.
自身免疫性多内分泌综合征(APSs),也称为自身免疫性多腺体综合征,是一组自身免疫性疾病,其特征是几种(至少两种)内分泌腺功能障碍同时出现。它们在遗传易感性人群中受环境因素影响而发病。自身免疫性多内分泌综合征可能伴随自身免疫性风湿性疾病并使其病情恶化——APS - 2和APS - 3最为常见。APS - 2包括例如桥本氏病、乳糜泻和类风湿关节炎(RA)同时存在。在APS - 3中,诸如RA、系统性红斑狼疮和干燥综合征等风湿性疾病可能与桥本氏病、1型糖尿病和性腺功能减退或其他内分泌病同时存在。未诊断出的内分泌疾病可能是风湿性疾病过程中观察到的代谢紊乱加剧的原因,导致风湿病治疗无效,还会增加因骨质疏松、心血管并发症甚至流产(例如桥本氏病合并甲状腺功能减退时,会增加妊娠丢失风险)导致的骨折发生率。能够进行全面的问诊非常重要,在体格检查时要注意可能的内分泌病症状以及其他自身免疫性疾病的特征(例如白癜风或艾迪生病中的皮肤色素沉着)。根据病史和体格检查结果,建议对各种APSs进行筛查。
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