Cumali GÖKÇE, Sema ASİLYÖRÜK, Gamze SERARSLAN, İhsan ÜSTÜN, Murat ÇELİK, Nigar YILMAZ, Edip UÇAR, Mehmet DEMİR, Hasan KAYA, Şerefettin CANDA

VİTİLİGOLU HASTALARDA HİPOTALAMO-HİPOFİZER-ADRENAL AKSIN VE HASTALIĞIN TUTULUMU İLE SÜRESİ ARASINDAKİ İLİŞKİNİN DEĞERLENDİRİLMESİ

Amaç: Vitiligo, herhangi bir yaşta ortaya çıkabilen, değişik büyüklükte ve sayıda, iyi sınırlı, süt beyazı renkte yamalar şeklinde görülen, melanosit yıkımı ile karakterize kazanılmış, ilerleyici, deri ve saç folikülünü tutan bir hastalıktır. Hastalığın etyopatogenezi hakkında çok şey bilinmese de hastalığa yönelik birçok hipotezler öne sürülmüştür. En önemli nedenlerinden biri otoimmünitedir. Bu hipotezi destekleyen en önemli verilerden biri de vitiligonun bazı otoimmün ve endokrin hastalıklarla (otoimmün poliendokrin sendromlarda olduğu gibi) birlikte görülmesidir. Adrenal yetmezlik de etyolojisinde çoğunlukla otoimmünitenin rol oynadığı bir hastalıktır. Adrenal yetmezliğin tanısında bu aksı değerlendiren çeşitli testler kullanılır. Serum bazal kortizol düzeyi tayini bunlardan biridir. Amacımız vitiligolu hastalarda serum bazal kortizol tayini ile hipotalamo- hipofizer- adrenal aksı (HPA) incelemektir.Gereç ve Yöntem: Çalışmaya, Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesine 2008–2009 yılları arasında başvuran ve vitiligo tanısı alan 27 hasta (11 erkek, 16 kadın) alındı. Hastalıkla ilgili demografik veriler, klinik ve laboratuar parametreleri incelendi.Bulgular ve Sonuç: Vitiligolu hastalarda yapılan analizler sonucunda serum bazal kortizol düzeyleri ile bu hastalığın tutulum şekli (jeneralize, fokal) ve süresi arasında anlamlı bir ilişkinin olmadığı tespit edildi. Bu bulgular, vitiligolu hastalarda HPA aksı değerlendirmede serum bazal kortizol düzeylerinin özellikle subklinik adrenal yetmezliği teşhis etmede yetersiz olduğunu ve ileri testlere gereksinim duyulduğunu göstermektedir. Bu araştırma, bilgilerimize göre literatürdeki vitiligolu hastalarda HPA aksı inceleyen ender çalışmalardan birisidir.

Anahtar Kelimeler:

Vitiligo, Adrenal Yetmezlik, Otoimmün Endokrin Poliglandüler Sendrom, HPA Aks, Serum Bazal Kortizol Düzeyi

EVALUATION OF HYPOTHALAMIC- PITUITARY-ADRENAL AXIS IN PATIENTS WITH VITILIGO AND ASSOCIATION BETWEEN THE INVOLVEMENT AND DURATION OF THE DISEASE

Objective: Vitiligo is a disease which can be occurred at any age with various size and number, well-circumscribed, milk-white incolor as seen in patches, characterized acquired by destruction of melanocytes, progressive, keeps the skin and hair follicle.Although a lot about the etiopathogenesis of diseases are unknown, many theses have been suggested for the disease. One of themost important etiologies is autoimmunity. One of the most important data which supports this hypothesis is; vitiligo is seen withsome autoimmune and endocrine diseases together (as in autoimmune polyendocrine syndromes). Adrenal insufficiency is also adisease which mainly plays a role in the etiology of autoimmunity and can bring vital risk and lead to crises if can not be diagnosed.Functions of the adrenal gland is controlled by neuroendocrine physiological system which known as the hypothalamo pituitaryadrenal axis. Our aim was to investigate the hypothalamo-pituitary-adrenal axis of patients with vitiligo by measuring basal serumcortisol level assays.Materials & Methods: For this purpose, patients who were admitted to the outpatient clinic and 27 of whom with diagnosis of vitiligo(11 men, 16 women) have been included in the current study. Diseases related to demographic data, clinical and laboratoryparameters were analyzed.Results and Conclusion: As a result of done analysis on patients with vitiligo, a significant relationship between basal serumcortisol levels and form of this disease involvement (generalized, focal) and the time period is not been observed. These findings inpatients with vitiligo, in the assessment of HPA axis, basal serum cortisol levels especially in diagnosing subclinical adrenalinsufficiency is inadequate and shows that further tests were required to indicate. According to our knowledge, this study is one thefew one in literature which examines the HPA axis on vitiligo patients.

Keywords:

Vitiligo, Adrenal Insufficiency, Autoimmune Endocrine Polyglandular Syndrome, HPA Axis, Basal Serum Cortisol Level,

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