Rheumatology Advance Access originally published online on September 11, 2008
Rheumatology 2008 47(11):1692-1697; doi:10.1093/rheumatology/ken338
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Testicular Sertoli cell function in male systemic lupus erythematosus
1Division of Rheumatology, 2Pediatric Laboratory, 3Division of Urology and 4Pediatric Rheumatology Unit, Department of Pediatrics, University of São Paulo, São Paulo, Brazil.
Correspondence to: C. A. A. Silva, Unidade de Reumatologia Pediátrica e Disciplina de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, sala 3133, São Paulo, SP, Brazil. E-mail: clovisaas{at}icr.hcnet.usp.br
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Abstract |
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Objective. To assess the testicular Sertoli cell function in male SLE patients.
Methods. Thirty-four consecutive patients were prospectively selected to evaluate serum inhibin B. Clinical features, treatment, semen analysis, urological evaluation, testicular ultrasound, hormones and anti-sperm antibodies were determined.
Results. Patients were subdivided into two groups: low serum inhibin B (Group 1, n = 8) and normal levels (Group 2, n = 26). The median sperm concentration (P = 0.024), total sperm count (P = 0.023) and total motile sperm count (P = 0.025) were lower in Group 1. Inhibin B levels were positively correlated with sperm concentration (r = 0.343), total motile sperm count (r = 0.357), and negatively correlated with follicule-stimulating hormone (FSH) (r = 0.699) and luteinizing hormone (r = 0.397). The median serum inhibin B was lower in SLE patients treated with intravenous cyclophosphamide (IVCYC) compared with those without this therapy (P = 0.031). Further evaluation of the 26 SLE patients with normal inhibin B and FSH levels revealed that medians of inhibin B/FSH ratio were lower in SLE patients with oligozoospermia compared with normozoospermia (P = 0.004). This ratio was also lower in SLE patients treated with IVCYC than those without this therapy (P = 0.04). In contrast, inhibin B serum level alone did not discriminate the later group of patients (P = 0.12).
Conclusions. This is the first study to identify a high frequency of testicular Sertoli cell dysfunction in male SLE associated with semen abnormalities. Further prospective studies are necessary to determine if inhibin levels and inhibin B/FSH ratio will be an earlier and useful marker of IVCYC toxicity in these patients.
KEY WORDS: Systemic lupus erythematosus, Male, Sperm, Hormone, Sertoli cell, Inhibin B
Submitted 17 March 2008;
revised version accepted 15 July 2008.
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