Autoimmune oophoritis as a mechanism of follicular dysfunction in women with 46,XX spontaneous premature ovarian failure

Objective

To assess the association between serum adrenal cortex autoantibodies and histologically confirmed autoimmune lymphocytic oophoritis.

Design

Controlled, prospective.

Setting

Tertiary research center.

Patient(s)

Two hundred sixty-six women with 46,XX spontaneous premature ovarian failure.

Intervention(s)

Ovarian biopsy in 10 women.

Main Outcome Measure(s)

Serum adrenal cortex autoantibodies assessed by indirect immunofluorescence and autoimmune oophoritis assessed by immunohistochemical lymphocyte markers.

Result(s)

We obtained a histologic diagnosis of autoimmune oophoritis in four women who tested positive for adrenal cortex autoantibodies and excluded this diagnosis in ovarian biopsies from six women who tested negative for adrenal cortex autoantibodies (4/4 vs. 0/6). Women with histologically confirmed autoimmune oophoritis had a greater total ovarian volume as assessed by transvaginal sonography (11.4 ± 5.6 mL vs. 1.5 ± 0.4 mL) (mean ± SEM). They were also more likely to have subclinical adrenal insufficiency and clinical signs of androgen deficiency (3/4 vs. 0/6). Overall, 10/266 women tested positive for adrenal cortex autoantibodies (3.8%, 95% confidence interval: 1.8%–6.5%).

Conclusion(s)

In women who present with 46,XX spontaneous premature ovarian failure as their primary concern there is a clear association between serum adrenal cortex autoantibodies and the presence of histologically confirmed autoimmune oophoritis.

Key Words:  Adrenal cortex autoantibodies , autoimmune oophoritis , premature ovarian failure , hypergonadotropic amenorrhea , hypergonadotropic hypogonadism , ovarian insufficiency , adrenal insufficiency , Addison disease