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Lupus and the Endocrine System

THE ENDOCRINE SYSTEM:   A powerful infantry of glands that affect virtually every cell and organ in the body – that with one blow may have one down for the count, waving a white flag of surrender.

Okay, that not might be the exact medical definition one would find on webMD, but for someone who suffers from endocrine issues, it probably hits the nail on the proverbial head pretty accurately.  For those who are unfamiliar with this army of glands in the body and what they do, look no further!  This blog will highlight what the endocrine system does, different diseases or deficiencies of the endocrine system, and how lupus and lupus medications may affect different areas of this complex system as well.   

The word endocrine is derived from the Greek words “endo” and “crinis” which means ‘to secrete within.”  This is fitting because the endocrine system is made up of the thyroid gland, parathyroid glands, adrenal glands, pituitary gland, pineal gland, pancreas, ovaries and testicles.  Theses glands produce and secrete hormones that maintain and regulate tissue function, metabolism, sleep, mood (oh dear), reproduction, growth and development.   No big deal, right? Wrong – every person needs a functioning endocrine system in order to survive and thrive.  

LET’S TALK ABOUT GLANDS:

Glands are essential for removing materials from the blood and secreting other substances, usually hormones, that play a role in maintaining homeostasis (fancy word for balance) in the body.  Glands are divided into two groups: endocrine and exocrine glands.  For this blog, we will be focusing only on the endocrine glands, which include:

Thyroid Gland:

This is a butterfly shaped organ that sits at the front of the neck and lies against the trachea. The thyroid secretes hormones that control protein synthesis, metabolic rate, development, and calcium homeostasis.  

Diseases of the thyroid:

Hyperthyroidism:  When your thyroid becomes overactive and produces too much of the hormone thyroxine it is called hyperthyroidism. This can accelerate your body’s metabolism significantly, causing sudden weight loss, sweating, a rapid or irregular heartbeat, and nervousness or irritability.  

Grave’s Disease: Sometimes when someone has hyperthyroidism, they also develop a disorder called Graves’ ophthalmopathy.  This disorder can cause the eyeballs to protrude and bulge out of the orbits and make the front of the eyes to become very dry, swollen and red.  Some people develop a goiter with this condition as well, which is a visual swelling of the neck.

Hypothyroidism: Hypothyroidism is the opposite of hyperthyroidism and is when your thyroid is underactive and doesn’t produce enough hormone.  This can upset the normal balance in the body and lead to obesity, joint pain, fatigue and even heart disease.  

Hashimoto’s Thyroiditis:  This is an autoimmune condition in which your immune system attacks the thyroid.  Sometimes referred to as chronic lymphocytic thyroiditis, this is the leading cause of hypothyroidism in the U.S.  

Cancer of the Thyroid: Thyroid cancer occurs in the cells of the thyroid.  Your thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight.  This type of cancer is rare in the U.S.  and is often highly treatable.  

Parathyroid Glands:

These are a collection of four small glands in the neck, located on the back of the thyroid gland. Parathyroid glands are responsible for secreting the hormone calcitonin, which regulates the amount of calcium within the blood and the bones.  

Diseases of Parathyroid Glands:

Hyperparathyroidism:  This is when there is an excess of parathyroid hormone in the bloodstream.  There are two types: Primary and Secondary.  Symptoms can range from mild to severe. Symptoms may include: osteoporosis, kidney stones, abdominal pain, excessive urination, depression, bone and joint pain, nausea, vomiting or loss of appetite, forgetfulness and weakness.

Hypoparathyroidism:  This is a pretty uncommon condition where the body secretes very low levels of parathyroid hormone (PTH).  This hormone is essential to regulating the balance of the body’s calcium and phosphorus levels.  

Adrenal Glands:

These are glands that are located above the kidneys and below the diaphragm that produce a variety of hormones including cortisol, aldosterone, and adrenaline.  The adrenal glands give the “fight or flight” rapid response when the body is in stressful situations.  

Diseases of the Adrenal Glands:

Cushing Syndrome:  Sometimes referred to as “hypercortisolism” this occurs when the body is exposed to high levels of the hormone cortisol over a long period of time.  The condition can occur when the body makes too much cortisol on its own or by taking oral corticosteroids.   Symptoms include a rounded face, pink and purple stretch marks, high blood pressure, bone loss, a fatty hump between the shoulders.  

Addison’s Disease:  This is a disorder, sometimes referred to as “adrenal insufficiency”  that occurs when the body produces dangerously low amounts of cortisol and aldosterone.  It can be life-threatening and can affect all age groups and sexes.  Symptoms include: weight loss, decreased appetite, low blood sugar, muscle pain, irritability, depression, hair loss, sexual dysfunction, salt craving, hyperpigmentation, abdominal pain.  

Congenital Adrenal Hyperplasia:  (CAH) is a group of genetic disorders that affect the adrenal glands which causes a person to lack the enzymes to produce the hormones cortisol, mineralocorticoids and androgens.   Those hormones are essential in regulating the metabolism, immune system, blood pressure and other essential functions.

Adrenal Fatigue:  This is a term for a collection of symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems that is believed to be associated with the adrenal gland.

Tumors: Adrenal cancer is very rare type of cancer of the adrenal glands.  It primarily affects children before the age of 5 and adults in their 40’s and 50’s.  It is an aggressive form of cancer, but with early diagnosis can be cured.  Not all tumors in the adrenal glands are cancer, some growths, such as adenomas or pheochromocytomas can develop in the adrenals as well.  

Pancreas:

The pancreas is an organ that is part of the digestive system and the endocrine system.  It sits in the abdominal cavity behind the stomach.  This gland produces several hormones, including insulin, glucagon, somatostatin and pancreatic polypeptide.  It also produces digestive enzymes that assist in the absorption of nutrients and help break down carbohydrates, proteins and lipids.   

Diseases of the Pancreas:

Type 1 Diabetes:  Usually known as “juvenile diabetes” or insulin-dependent diabetes, this is a chronic disease in which the pancreas produces little or no of the hormone insulin, which allows sugar to be made into energy in the cells.  

Type 2 Diabetes: A far more common type of diabetes where the body becomes resistant to insulin.  Also known

The glucometer, test strips, insulin against the backdrop of record results

as “adult-onset” or noninsulin-dependent diabetes, this is a chronic disease that affects the way the body metabolizes sugar.  With this type of diabetes, the body either is resistant to the effects of insulin or doesn’t produce enough insulin to stay at a normal healthy level.

Pancreatic Cancer: Pancreatic cancer usually begins in the pancreas tissue and can  spread rapidly to nearby organs. It is seldom detected in its early stages.  Some signs of pancreatic cancer are diabetes, weight loss, jaundice or pain in the upper abdomen.

Cystic Fibrosis: Cystic fibrosis is an inherited genetic disorder that affects the cells that produce mucus, digestive juices and sweat. These secreted fluids become sticky and thick and plug up tubes, ducts and passageways, especially in the lungs and pancreas.  This can irritate the pancreas and cause swelling (pancreatitis).

Pancreatitis:  This is inflammation in the pancreas that occurs when the digestive enzymes cause irritation and swelling. Pancreatitis can be acute or chronic and can range from mild to life-threatening.  Symptoms include: upper abdominal pain (usually worse after eating), fever, nausea, vomiting, tender abdomen, rapid pulse.  It is always important to seek immediate medical attention if you are experiencing abdominal pain that is severe and you believe you may have pancreatitis.

Ovaries:

An ovary is a endocrine gland and reproductive organ usually found in pairs as part of the female reproductive system.  They are found on the lateral wall of the uterus.

Diseases of the Ovaries:

Polycystic ovary syndrome (PCOS):  This is a common disorder of the endocrine system among women of childbearing age. Women with PCOS usually have enlarged ovaries that contain follicles of fluid. Symptoms include: irregular menstrual periods, acne, obesity, excess hair growth.  The exact cause is unknown, but early treatment and weight loss will reduce long-term issues like type 2 diabetes and heart disease.

Premature Ovarian Failure:  Premature ovarian failure or primary ovarian insufficiency,  is the loss of normal ovarian function before the age 40. When ovaries stop working, they do not produce the normal amounts of estrogen or release eggs regularly, resulting often in infertility.  Restoring estrogen levels in women with this problem helps prevent complications like osteoporosis, that can result because of low estrogen.

Turner Syndrome:  This is a chromosomal disorder that affects females.  This can cause a variety medical and developmental problems, including infertility, heart defects, short height, failure to start puberty, and learning disabilities.

Ovarian Cancer:   Usually, early-stage ovarian cancer rarely causes any problems.  More advanced stage may present with such symptoms as: abdominal bloating, weight loss, feeling full, discomfort in pelvis, changes in bowel movements, frequent need to urinate.  

Amenorrhea: This is a menstrual condition that is diagnosed by the absence of menstrual periods for more than three monthly cycles.  There are two types: primary and secondary.  Primary is classified when a female had started puberty but has not started menstruation over the age of 15.  Secondary, occurs when a woman who has had a period stops menstruating for a period of over 6 months or more.  Common causes of secondary amenorrhea include endocrine disorders such as an under or overactive thyroid gland, obesity, excessive exercise, body fat percentages under 15 to 17 percent and sudden weight loss.

Testicles:

The testicle, like the ovary is also part of the endocrine system and reproductive system.  Their primary function is to produce sperm, androgens and testosterone in males.  The most prominent diseases of testicles are: testicular cancer, swelling of a testicle, and inflammation of the epididymis.

The Pineal Gland:

This small pine cone shaped gland is located near the center of the brain between the two hemispheres.  The pineal gland produces the hormone melatonin that helps control sleep patterns.

Tumors: There are three types of pineal gland tumors: gliomas, germ cell tumors and pineal cell tumors. These tumors usually to develop in the region of the gland, and the symptoms may include seizures, headaches, nausea and vomiting, changes in visual perception and memory problems.

Pituitary Gland:

The pituitary gland is an endocrine gland that is roughly the size of a pea, that protrudes off the bottom of the base of the brain.  The pituitary gland is responsible for regulating hormones that control stress, growth, reproduction, lactation and blood pressure.

Pituitary Disease: Overproduction or underproduction of a pituitary hormone will affect many different areas and can cause Cushing’s disease, growth hormone deficiency, Sheehan Syndrome, and other issues.

LUPUS AND ENDOCRINE ISSUES:

Prednisone:

This medication belongs to a group of drugs called corticosteroids and is often used to treat lupus, arthritis, lung issues, and other issues.  It can be a life-saving drug but it can also affect the organs that make up the endocrine system, especially the adrenal glands.  Taking prednisone long-term can suppress the function of the adrenal glands and reduce the natural level of cortisol that the body makes.  This may result in adrenal insufficiency or adrenal crisis.  It is extremely important to take prednisone exactly how a doctor prescribes it, never stop or skip a dose.   Other hormones that may be suppressed by taking prednisone are dehydroepiandrosterone, androsterone, aldosterone and tetrahydrocorticosterone.  Taking a DHEA supplement while on prednisone may help counteract any negative endocrine effects.  

If you have been taking prednisone for an extended period of time, it is also important to talk to your doctor about any upcoming procedures or surgeries you may be having.  Many people require a pre-op  “stress dose” of prednisone to ensure adrenal insufficiency does not occur.   Never assume that all your doctors are “in the know” about how long you have been on prednisone and how much you have been taking.  Time to be your own advocate here and make sure they are aware before you have any procedures done.  Thyroid:

According to the Johns Hopkins Lupus Center, roughly 6 percent of people with lupus have hypothyroidism and 2 percent suffer from hyperthyroidism. A study published in 2009 from the Journal of Clinical Rheumatology discovered over six percent of those with lupus had thyroid problems caused by autoimmune thyroid disease, like Hashimoto’s, compared with two percent in the general population. Although there has not been a direct link found between lupus and thyroid,  it does seem evident that those suffering from one autoimmune disorder run the risk of developing another due to possible immune-system predispositions.  

Autoimmune Hypophysitis:

Autoimmune hypophysitis is defined as inflammation of the pituitary gland due to an autoimmune response.  Symptoms vary depending on the area of the pituitary that is affected, but can result in adrenal insufficiency, hypothyroidism, and diabetes. It is believed that 80% of patients who have pituitary antibodies, also have antibodies to thyroid glands, connecting those who have thyroid issues possible to autoimmune hypophysitis.    

Hormones:

No one knows the exact cause of lupus, however there has been much discussion regarding the role of the sex hormone estrogen and the development of the disease.  Since 90 percent of those with lupus are female, scientists have wondered for some time about the estrogen and immune system connection.   Additionally, most children who are diagnosed with lupus are at the age when they are entering puberty.  Since hormones are the body’s messengers that regulate several body functions, when there is the slightest off balance, it can cause a lot of trouble.  Anecdotally, many women have experienced an increase in disease activity before and during menstruation and terrible flare-up’s postpartum, due to fluctuations in hormones.

HOW TO HELP KEEP YOUR ENDOCRINE SYSTEM HEALTHY:

  • Maintain a healthy diet and eat foods rich in the omega’s, which can be found in salmon, halibut, walnuts, cashews and avocados
  • Skip the junk!  Too much sugar and salt and processed foods can affect your endocrine system and increase your risk of developing Type 2 Diabetes. Side portrait of healthy young woman doing stomach crunches near the beach
  • Be aware of your family history and talk openly with your doctor about any concerns you may have regarding your endocrine system
  • Talk to your doctor before you talk any supplements for “boosting” your adrenal glands
  • Reduce stress by: getting 7-8 hours of sleep each night, meditation, breathing exercises, calm and repetitive activities (like knitting, reading, painting)

 

Sources:

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**All resources provided by Molly’s Fund are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.