INTERESTING TIMES

Modulation of autoimmune rheumatic diseases by oestrogen and progesterone
• Grant C. Hughes & Divaker Choubey
Nature Reviews Rheumatology 10, 740–751 (2014) doi:10.1038/nrrheum.2014.144
Published online 26 August 2014
http://www.nature.com/nrrheum/journal/v10/n12/full/nrrheum.2014.144.html
Abstract
Sexual dimorphism is evident in the risk and expression of several human autoimmune diseases. Differences in disease manifestations observed between sexes are likely to involve immunomodulation by sex steroids, nonhormonal factors encoded by genes on the X and Y chromosomes, and immunological phenomena unique to pregnancy. In systemic lupus erythematosus (SLE), and perhaps other autoantibody-mediated diseases, oestrogen seems to increase the risk of disease in genetically predisposed women by targeting key immune pathways, including the type 1 interferon (IFN) response, differentiation of CD4+ T helper cells and survival of autoreactive B cells. By contrast, progesterone seems to reduce the risk of SLE by counteracting the effects of oestrogen on some of these same pathways, which suggests that the balance between oestrogen and progesterone can determine disease expression. In this Review we focus on the roles of the sex steroid hormones oestrogen and progesterone in modulating the risk and expression of SLE and rheumatoid arthritis. Intensive research in this area promises to identify novel therapeutic strategies and improve understanding of the immunological requirements and complications of pregnancy, and is expected to define the mechanisms behind sexual dimorphism in autoimmunity, immunity and other aspects of human health—a newly announced directive of the NIH.

The "rare syndromes" that are associated with multiple lipomas, according to my minor surgery notes, are "Gardner's syndrome and two benign conditions--multiple symmetrical lipomatosis and Dercum's disease. In the latter, the lipomas are painful". I had to look it up because my sister's husband is covered in them, and because in the last 2 years I've begun to develop them all over my body including strange locations such as over the biceps femoris tendon in my posteriolateral popliteal area--very small so far--I suspect a hormonal etiology. More occur in women after menopause, and familial types onset at adolescence. With some types there is an increased incidence of breast, endometrial and thyroid cancer. Sounds like it may be related with estrogen dominance. This would be supported by the increased incidence with obesity. There is also an association with multiple endocrine neoplasia type I (lipomas and pancreatic, parathyroid, pitutitary tumors). The list of hormonal associations increases the deeper I dig. There are also fat deposits associated with spina bifida. Looks like nobody has studied hormones in lipomatosis patients, but based on my short survey I have just now formed the opinion that is expressed in the title of this entry.
( notes: fyi, when something is marked with triple questionmarks it means that the source is not convincing and I kinda doubt it, but I'm recording it for future reference anyway )

postpartum depression is common
new neurobiological model to explain:
decr estrogen-->incr MAO-A binding-->low mood & risk for depression
Arch Gen Psychiatry. 2010;67:468-474.
( notes )

DrWelch txs low T if pt has sx and levels below 3000
( notes from Miller's 2010 pharm class )

Why progesterone causes mood changes
( behind cut )