From the Guidelines
Autoimmune causes of premature ovarian insufficiency (POI) include autoimmune disorders that affect the ovaries, such as those associated with 21-hydroxylase antibodies (21OH-Ab) or adrenocortical antibodies (ACA).
Autoimmune Causes
- 21OH-Ab: associated with autoimmune adrenalitis, which can also affect the ovaries and lead to POI 1
- ACA: associated with autoimmune adrenalitis and can also be a cause of POI 1
- Thyroid peroxidase antibodies (TPO-Ab): although not directly mentioned as a cause of POI, it is mentioned in the context of testing for autoantibodies in women with POI 1
Investigation
Screening for 21OH-Ab (or ACA) should be considered in women with POI of unknown cause or if an immune disorder is suspected 1. If 21OH-Ab/ACA and TPO-Ab are negative in women with POI, there is no indication for re-testing later in life, unless signs or symptoms of these endocrine diseases develop 1.
From the Research
Autoimmune Causes of Premature Ovarian Insufficiency (POI)
The autoimmune causes of POI are estimated to account for 4-30% of cases 2, 3. The ovaries are a common target for autoimmune attacks, and an autoimmune etiology of POI should always be considered, especially in the presence of anti-oocyte antibodies (AOAs), autoimmune diseases, or lymphocytic oophoritis in biopsy 2.
Associated Autoimmune Conditions
POI can occur in isolation, but is often associated with other autoimmune conditions, including:
- Concordant thyroid disorders such as hypothyroidism, Hashimoto thyroiditis, and Grave's disease 2
- Adrenal autoimmune disorders, such as Addison's disease 2, 3
- Autoimmune polyglandular syndrome (APS) 2, 4
- Diabetes mellitus, with POI developing in roughly 2.5% of women with diabetes 2
Immune Mechanisms
The immune mechanisms involved in autoimmune POI include:
- Loss of self-tolerance, resulting in an immune response against self-tissues and autoimmunity 4
- Presence of lymphocytic oophoritis in ovarian samples of patients with POI, providing histopathological evidence of autoimmune ovarian involvement 4, 3
- Detection of anti-ovarian antibodies in some patients with POI, suggesting an autoimmune mechanism 3, 5
Diagnostic Tools
The major diagnostic tool for autoimmune POI is the presence of autoantibodies against various ovarian components, which strongly support the option of autoimmune etiology of POI 6. However, there is no clinically proven sensitive and specific serum test to confirm the diagnosis of autoimmune POI or to anticipate the patient's chance of developing POI or associated diseases 3.