title: Premature Ovarian Failure: An Association with Autoimmune Diseases.
abstract: BACKGROUND
  Premature Ovarian Failure (POF) is the cessation of ovarian function before the age of 40 years. POF is reported to be associated with autoimmune diseases in 20-30% of cases.
  
  
  OBJECTIVE
  Patients presenting with idiopathic POF were screened for the presence of autoimmune disorders.
  
  
  METHODS
  Twenty patients with idiopathic POF were included in the study. Baseline investigation in all subjects included fasting serum FSH, LH, E2, progesterone, free T3, free T4, Thyroid-Stimulating Hormone (TSH) and Anti-Thyroperoxidase (anti-TPO) antibodies, testosterone and Dehydroepiandrosterone (DHEAS) levels. Fasting and post-glucose (2 hours after 75g of oral glucose) serum calcium and phosphate were estimated using appropriate assays in biochemistry laboratory.
  
  
  RESULTS
  Seven patients (35%), who presented with secondary amenorrhea, had thyroid disorders and were already on thyroxine replacement therapy. One patient also had vitiligo. There was no history of adrenal disorder. Anti-TPO levels were elevated in two (10%) patients of secondary amenorrhea group. The levels of serum testosterone were low in three patients. Serum DHEAS levels were low in 13 patients. Blood sugar levels (fasting and 2 hour post 75g glucose load) and fasting insulin levels were normal. Serum calcium and phosphate levels were normal in all the patients.
  
  
  CONCLUSIONS
  Thyroid autoimmunity is the most common autoimmune disease associated with POF. The finding of low DHEAS in a large percentage of patients (65%), suggests possibility of adrenal dysfunction. This requires further testing for adrenal reserve and adrenal autoantibodies.
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynecology, Mayo Institute of Medical Sciences , Barabanki, U.P., India .
authors.lastname: Ayesha
authors.affiliation: Assistant Professor, Department of Obstetrics and Gynecology, Mayo Institute of Medical Sciences , Barabanki, U.P., India .
authors.forename: Vandana
authors.initials: V
authors.lastname: Jha
authors.affiliation: Professor, Department of Obstetrics and Gynecology, Maulana Azad Medical College , New Delhi, India .
authors.forename: Deepti
authors.initials: D
authors.lastname: Goswami
keywords: Amenorrhea; Autoimmunity; Thyroid autoantibodies