Zaburzenia hormonalne u pacjentów ze stwardnieniem rozsianym Artykuł przeglądowy
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Opublikowane:
cze 30, 2025
Słowa kluczowe:
stwardnienie rozsiane, zaburzenia hormonalne, choroby tarczycy
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Abstrakt
Stwardnienie rozsiane (SM, sclerosis multiplex) to przewlekła zapalno-neurodegeneracyjna choroba ośrodkowego układu nerwowego o podłożu autoimmunologicznym, w której hormony płciowe odgrywają istotną rolę już od początku choroby i mają wpływ na jej przebieg. Z drugiej strony, u pacjentów z SM częściej obserwuje się zaburzenia hormonalne ze strony tarczycy, zwłaszcza w przebiegu choroby Hashimoto.
SM występuje częściej u kobiet, a hormony płciowe, zwłaszcza estrogeny i progesteron, modulują aktywność choroby w różnych etapach życia, w tym w ciąży i menopauzie. Zaburzenia hormonalne, takie jak hiperprolaktynemia, nieregularne miesiączki i choroby tarczycy, mogą wpływać na przebieg SM oraz odpowiedź immunologiczną. Hormonalna terapia zastępcza, estrogeny i doustna antykoncepcja mogą mieć efekt ochronny, ale wymagają indywidualnej oceny, ponieważ hormony znacząco wpływają na aktywność choroby, postęp niepełnosprawności i jakość życia pacjentów.
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Bibliografia
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3. Rommer PS, Ellenberger D, Hellwig K et al. Relapsing and progressive MS: the sex-specific perspective. Ther Adv Neurol Disord. 2020; 13: 1756286420956495.
4. Ribbons KA, McElduff P, Boz C et al. Male sex is independently associated with faster disability accumulation in relapse onset MS but not in primary progressive MS. PLoS One. 2015; 10(6): e0122686.
5. Ysrraelit MC, Correale J. Impact of sex hormones on immune function and multiple sclerosis development. Immunology. 2019;156(1):9-22. https://doi.org/10.1111/imm.13004.
6. McCombe PA. The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do? Expert Rev Neurother. 2022; 22(5): 377-92. https://doi.org/10.1080/14737175.2022.2060079.
7. Carbone L, Di Girolamo R, Conforti A et al. Ovarian reserve in patients with multiple sclerosis: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2023; 163(1): 11-22. https://doi.org/10.1002/ijgo.14757.
8. Ucciferri CC, Dunn SE. Effect of puberty on the immune system: Relevance to multiple sclerosis. Front Pediatr. 2022; 10: 1059083. https://doi.org/10.3389/fped.2022.1059083.
9. Espinoza-López DA, Huerta-Franco MR, Zermeño-Pöhls F et al. Sex hormones, obstetric and gynecologic characteristics of multiple sclerosis women with and without relapse. Gac Med Mex. 2025; 161(3): 274-79.
10. Kopp TI, Pinborg A, Glazer CH et al. Women with female infertility seeking medically assisted reproduction are not at increased risk of developing multiple sclerosis. Hum Reprod. 2022; 37(6): 1324-33. https://doi.org/10.1093/humrep/deac041.
11. Hellwig K, Chen LH, Stancyzk FZ et al. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility. PLoS One. 2016; 11(3): e0149094. https://doi.org/10.1371/journal.pone.0149094.
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13. Pozzilli C, De Giglio L, Barletta VT et al. Oral contraceptives combined with interferon β in multiple sclerosis. Neurol Neuroimmunol Neuroinflamm. 2015; 2(4): e120. https://doi.org/10.1212/NXI.0000000000000120.
14. Zapata LB, Oduyebo T, Whiteman MK et al. Contraceptive use among women with multiple sclerosis: a systematic review. Contraception. 2016; 94(6): 612-20. https://doi.org/10.1016/j.contraception.2016.07.013.
15. Bove R, Vaughan T, Chitnis T et al. Women’s experiences of menopause in an online MS cohort: A case series. Mult Scler Relat Disord. 2016; 9: 56-9. https://doi.org/10.1016/j.msard.2016.06.015.
16. Baroncini D, Annovazzi PO, De Rossi N et al. Impact of natural menopause on multiple sclerosis: a multicentre study. J Neurol Neurosurg Psychiatry. 2019; 90(11): 1201-6. https://doi.org/10.1136/jnnp-2019-320587.
17. Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler. 2014; 20(5): 520-6. https://doi.org/10.1177/1352458513519181.
18. Lorefice L, Frau J, Coghe G et al. Assessing the burden of vascular risk factors on brain atrophy in multiple sclerosis: A case-control MRI study. Mult Scler Relat Disord. 2019; 27: 74-8. https://doi.org/10.1016/j.msard.2018.10.011.
19. Lorefice L, D’Alterio MN, Firinu D et al. Impact of Menopause in Patients with Multiple Sclerosis: Current Perspectives. Int J Womens Health. 2023; 15: 103-9. https://doi.org/10.2147/IJWH.S334719.
20. Silverman HE, Bostrom A, Nylander AN et al. Association of Menopause With Functional Outcomes and Disease Biomarkers in Women With Multiple Sclerosis. Neurology. 2025; 28; 104(2): e210228. https://doi.org/10.1212/WNL.0000000000210228.
21. Hsu S, Bove R. Hormonal Therapies in Multiple Sclerosis: a Review of Clinical Data. Curr Neurol Neurosci Rep. 2024; 24(1): 1-15. https://doi.org/10.1007/s11910-023-01326-7.
22. Davis SR. Understanding weight gain at menopause. Climacteric. 2012; 15: 419-29. https://doi.org/10.3109/13697137.2012.707385.
23. Juutinen L, Ahinko K, Hagman S et al. Immunometabolic profiling in menopausal women with multiple sclerosis: the role of adipokines and hormone therapy. BMJ Neurol Open. 2025; 7(2): e001295.
24. Escribano BM, Valdevira ME, Muñoz-Jurado A et al. The Impact of Sex Hormones on Transcranial Magnetic Stimulation Against the Oxidative Stress in the Pathogenesis of Multiple Sclerosis. Biomolecules. 2025; 15(12): 1714.
25. Alvarez-Sanchez N, Dunn SE. Potential biological contributers to the sex difference in multiple sclerosis progression. Front Immunol. 2023; 14: 1175874. https://doi.org/10.3389/fimmu.2023.1175874.
26. Da Costa R, Szyper-Kravitz M, Szekanecz Z et al. Ferritin and prolactin levels in multiple sclerosis. Isr Med Assoc J. 2011; 13(2): 91-5.
27. Markianos M, Koutsis G, Evangelopoulos ME et al. Serum and cerebrospinal fluid prolactin levels in male and female patients with clinically-isolated syndrome or relapsing-remitting multiple sclerosis. J Neuroendocrinol. 2010; 22: 503-8.
28. Golparvar S, Naghavi S, Adibi I. Hyperprolactinemia as a manifestation of multiple sclerosis attack. BMJ Neurol Open. 2025; 7(2): e000971. https://doi.org/10.1136/bmjno-2024-000971.
29. Correale J, Farez MF, Ysrraelit MC. Role of prolactin in B cell regulation in multiple sclerosis. J Neuroimmunol. 2014; 269: 76-86.
30. Zhornitsky S, Yong VW, Weiss S et al. Prolactin in multiple sclerosis. Mult Scler. 2013; 19(1): 15-23.
31. de Carvalho Jennings Pereira WL, Flauzino T, Alfieri DF et al. Prolactin is Not Associated with Disability and Clinical Forms in Patients with Multiple Sclerosis. Neuromolecular Med. 2020; 22(1): 73-80.
32. Dobson R, Giovannoni G. Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis. J Neurol. 2013; 260(5): 1272-85. https://doi.org/10.1007/s00415-012-6790-1.
33. Wawrzyniak S, Rakoca M, Kułakowska A et al. Multiple sclerosis and autoimmune diseases – a case control study. Neurologia i Neurochirurgia Polska. 2023; 57(4): 344-51. https://doi.org/10.5603/PJNNS.a2023.0038.
34. Poursadeghfard M, Mallahzadeh A, Hamidi A et al. Thyroid auto-antibodies in newly diagnosed multiple sclerosis patients: A cross sectional study. Health Sci Rep. 2024; 7(7): e2247. https://doi.org/10.1002/hsr2.2247.
35. Perga S, Martire S, Montarolo F et al. The Footprints of Poly-Autoimmunity: Evidence for Common Biological Factors Involved in Multiple Sclerosis and Hashimoto’s Thyroiditis. Front Immunol. 2018; 9: 311. https://doi.org/10.3389/fimmu.2018.00311.
36. Cui W, Wang B, Shi K et al. Causal relationship between thyroid function and multiple sclerosis: A bidirectional Mendelian randomization study. Medicine (Baltimore). 2024; 103(37): e39709. https://doi.org/10.1097/MD.0000000000039709.
37. Rigoni E, Dorsey R, Malik O et al. Development of Autoimmune Thyroid Disease in Multiple Sclerosis Patients Post-Alemtuzumab Improves Treatment Response. J Clin Endocrinol Metab. 2020; 105(9): dgaa453. https://doi.org/10.1210/clinem/dgaa453.
38. Rashad NM, Amer MG, Reda Ashour WM et al. The pattern of thyroiditis in multiple sclerosis: a cross-sectional study in a tertiary care hospital in Egypt. Egypt J Intern Med. 2020; 32(1): 17. https://doi.org/10.1186/s43162-020-00017-w.
39. Ruchała M, Szczepanek-Parulska E. Objawy neurologiczne w najczęstszych chorobach endokrynologicznych. Neurol Dypl. 2015; 10(6): 34-40.
2. Salpietro V, Polizzi A, Recca G et al. The role of puberty and adolescence in the pathobiology of pediatric multiple sclerosis. Multiple Scler Demyelinating Disorders. 2018; 3: 1-10.
3. Rommer PS, Ellenberger D, Hellwig K et al. Relapsing and progressive MS: the sex-specific perspective. Ther Adv Neurol Disord. 2020; 13: 1756286420956495.
4. Ribbons KA, McElduff P, Boz C et al. Male sex is independently associated with faster disability accumulation in relapse onset MS but not in primary progressive MS. PLoS One. 2015; 10(6): e0122686.
5. Ysrraelit MC, Correale J. Impact of sex hormones on immune function and multiple sclerosis development. Immunology. 2019;156(1):9-22. https://doi.org/10.1111/imm.13004.
6. McCombe PA. The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do? Expert Rev Neurother. 2022; 22(5): 377-92. https://doi.org/10.1080/14737175.2022.2060079.
7. Carbone L, Di Girolamo R, Conforti A et al. Ovarian reserve in patients with multiple sclerosis: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2023; 163(1): 11-22. https://doi.org/10.1002/ijgo.14757.
8. Ucciferri CC, Dunn SE. Effect of puberty on the immune system: Relevance to multiple sclerosis. Front Pediatr. 2022; 10: 1059083. https://doi.org/10.3389/fped.2022.1059083.
9. Espinoza-López DA, Huerta-Franco MR, Zermeño-Pöhls F et al. Sex hormones, obstetric and gynecologic characteristics of multiple sclerosis women with and without relapse. Gac Med Mex. 2025; 161(3): 274-79.
10. Kopp TI, Pinborg A, Glazer CH et al. Women with female infertility seeking medically assisted reproduction are not at increased risk of developing multiple sclerosis. Hum Reprod. 2022; 37(6): 1324-33. https://doi.org/10.1093/humrep/deac041.
11. Hellwig K, Chen LH, Stancyzk FZ et al. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility. PLoS One. 2016; 11(3): e0149094. https://doi.org/10.1371/journal.pone.0149094.
12. Otero-Romero S, Carbonell-Mirabent P, Midaglia L et al. Oral contraceptives do not modify the risk of a second attack and disability accrual in a prospective cohort of women with a clinically isolated syndrome and early multiple sclerosis. Mult Scler. 2022; 28(6): 950-7. https://doi.org/10.1177/13524585211053001.
13. Pozzilli C, De Giglio L, Barletta VT et al. Oral contraceptives combined with interferon β in multiple sclerosis. Neurol Neuroimmunol Neuroinflamm. 2015; 2(4): e120. https://doi.org/10.1212/NXI.0000000000000120.
14. Zapata LB, Oduyebo T, Whiteman MK et al. Contraceptive use among women with multiple sclerosis: a systematic review. Contraception. 2016; 94(6): 612-20. https://doi.org/10.1016/j.contraception.2016.07.013.
15. Bove R, Vaughan T, Chitnis T et al. Women’s experiences of menopause in an online MS cohort: A case series. Mult Scler Relat Disord. 2016; 9: 56-9. https://doi.org/10.1016/j.msard.2016.06.015.
16. Baroncini D, Annovazzi PO, De Rossi N et al. Impact of natural menopause on multiple sclerosis: a multicentre study. J Neurol Neurosurg Psychiatry. 2019; 90(11): 1201-6. https://doi.org/10.1136/jnnp-2019-320587.
17. Bove R, Chitnis T. The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler. 2014; 20(5): 520-6. https://doi.org/10.1177/1352458513519181.
18. Lorefice L, Frau J, Coghe G et al. Assessing the burden of vascular risk factors on brain atrophy in multiple sclerosis: A case-control MRI study. Mult Scler Relat Disord. 2019; 27: 74-8. https://doi.org/10.1016/j.msard.2018.10.011.
19. Lorefice L, D’Alterio MN, Firinu D et al. Impact of Menopause in Patients with Multiple Sclerosis: Current Perspectives. Int J Womens Health. 2023; 15: 103-9. https://doi.org/10.2147/IJWH.S334719.
20. Silverman HE, Bostrom A, Nylander AN et al. Association of Menopause With Functional Outcomes and Disease Biomarkers in Women With Multiple Sclerosis. Neurology. 2025; 28; 104(2): e210228. https://doi.org/10.1212/WNL.0000000000210228.
21. Hsu S, Bove R. Hormonal Therapies in Multiple Sclerosis: a Review of Clinical Data. Curr Neurol Neurosci Rep. 2024; 24(1): 1-15. https://doi.org/10.1007/s11910-023-01326-7.
22. Davis SR. Understanding weight gain at menopause. Climacteric. 2012; 15: 419-29. https://doi.org/10.3109/13697137.2012.707385.
23. Juutinen L, Ahinko K, Hagman S et al. Immunometabolic profiling in menopausal women with multiple sclerosis: the role of adipokines and hormone therapy. BMJ Neurol Open. 2025; 7(2): e001295.
24. Escribano BM, Valdevira ME, Muñoz-Jurado A et al. The Impact of Sex Hormones on Transcranial Magnetic Stimulation Against the Oxidative Stress in the Pathogenesis of Multiple Sclerosis. Biomolecules. 2025; 15(12): 1714.
25. Alvarez-Sanchez N, Dunn SE. Potential biological contributers to the sex difference in multiple sclerosis progression. Front Immunol. 2023; 14: 1175874. https://doi.org/10.3389/fimmu.2023.1175874.
26. Da Costa R, Szyper-Kravitz M, Szekanecz Z et al. Ferritin and prolactin levels in multiple sclerosis. Isr Med Assoc J. 2011; 13(2): 91-5.
27. Markianos M, Koutsis G, Evangelopoulos ME et al. Serum and cerebrospinal fluid prolactin levels in male and female patients with clinically-isolated syndrome or relapsing-remitting multiple sclerosis. J Neuroendocrinol. 2010; 22: 503-8.
28. Golparvar S, Naghavi S, Adibi I. Hyperprolactinemia as a manifestation of multiple sclerosis attack. BMJ Neurol Open. 2025; 7(2): e000971. https://doi.org/10.1136/bmjno-2024-000971.
29. Correale J, Farez MF, Ysrraelit MC. Role of prolactin in B cell regulation in multiple sclerosis. J Neuroimmunol. 2014; 269: 76-86.
30. Zhornitsky S, Yong VW, Weiss S et al. Prolactin in multiple sclerosis. Mult Scler. 2013; 19(1): 15-23.
31. de Carvalho Jennings Pereira WL, Flauzino T, Alfieri DF et al. Prolactin is Not Associated with Disability and Clinical Forms in Patients with Multiple Sclerosis. Neuromolecular Med. 2020; 22(1): 73-80.
32. Dobson R, Giovannoni G. Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis. J Neurol. 2013; 260(5): 1272-85. https://doi.org/10.1007/s00415-012-6790-1.
33. Wawrzyniak S, Rakoca M, Kułakowska A et al. Multiple sclerosis and autoimmune diseases – a case control study. Neurologia i Neurochirurgia Polska. 2023; 57(4): 344-51. https://doi.org/10.5603/PJNNS.a2023.0038.
34. Poursadeghfard M, Mallahzadeh A, Hamidi A et al. Thyroid auto-antibodies in newly diagnosed multiple sclerosis patients: A cross sectional study. Health Sci Rep. 2024; 7(7): e2247. https://doi.org/10.1002/hsr2.2247.
35. Perga S, Martire S, Montarolo F et al. The Footprints of Poly-Autoimmunity: Evidence for Common Biological Factors Involved in Multiple Sclerosis and Hashimoto’s Thyroiditis. Front Immunol. 2018; 9: 311. https://doi.org/10.3389/fimmu.2018.00311.
36. Cui W, Wang B, Shi K et al. Causal relationship between thyroid function and multiple sclerosis: A bidirectional Mendelian randomization study. Medicine (Baltimore). 2024; 103(37): e39709. https://doi.org/10.1097/MD.0000000000039709.
37. Rigoni E, Dorsey R, Malik O et al. Development of Autoimmune Thyroid Disease in Multiple Sclerosis Patients Post-Alemtuzumab Improves Treatment Response. J Clin Endocrinol Metab. 2020; 105(9): dgaa453. https://doi.org/10.1210/clinem/dgaa453.
38. Rashad NM, Amer MG, Reda Ashour WM et al. The pattern of thyroiditis in multiple sclerosis: a cross-sectional study in a tertiary care hospital in Egypt. Egypt J Intern Med. 2020; 32(1): 17. https://doi.org/10.1186/s43162-020-00017-w.
39. Ruchała M, Szczepanek-Parulska E. Objawy neurologiczne w najczęstszych chorobach endokrynologicznych. Neurol Dypl. 2015; 10(6): 34-40.