LAUSR

Objective: Fibromuscular dysplasia(FMD) mostly affects women in reproductive age. It has been suggested that FMD might be related to female hormone levels or contraceptive use. Therefore, the aim of the ARCADIA-POL substudy ARCADIA-GYN was to perform detailed, prospective obstetrics and gynaecological evaluation of women with FMD. Design and method: We enrolled in the ARCADIA-GYN study 42 women with FMD, ages between 18–46 years old and 45 age-matched healthy, normotensive women who have regular menstruation. By means of LC-MS/MS we analysed plasma steroid profile: estrogen, progesterone, testosterone, aldosterone, cortisol, 18-oxo-cortisol, 18-hydrocortisol, cortisone, 11-deoxycortisol, 21-deoxycortisol, corticosterone, 11-deoxycortisone, progesterone, 17-OH progesterone, pregnenolone, androstenedione, DHEA, DHEA-SO4. Blood samples in all subjects were collected in luteal phase while women stayed without any hormonal contraceptive. FMD was diagnosed based on ARCADIA-POL protocol as published previously. No signs of arterial lesions and/or disturbances in blood flow were found in Doppler duplex evaluations of carotid and renal arteries in control subjects. Results: 42 patients with FMD (34.2 ± 8.1years), predominantly with renal FMD, were compared to 45 healthy, normotensive women (34.0 ± 5.4years; p = 0.88). Hypertension was diagnosed in 88.1% (37) women with FMD. In women with FMD we found lower plasma levels of progesterone (5.1 inter quartile range [IQR] 2.0–8.2 vs 7.6 IQR 3.3–12.5ng/ml;p = 0.017),testosterone (0.20 IQR 0.15–0.28 vs 0.25 IQR 0.18–0.36ng/ml; p = 0.036), DHEA (3.6 IQR 2.6–4.3 vs 4.5 IQR 2.9–6.6ng/ml;p = 0.012), DHEAS04 (1167 IQR 819–1535 vs 1579 IQR 1197–1980ng/ml;p = 0.04) and 11-deoxycortisol (0.09 IQR 0.05–0.12 vs 0.14 IQR 0.09–0.18ng/ml;p = 0.002) as compared to control group. There were no significant differences in other analyzed hormones. There were no differences in steroid profile evaluations between patients with unifocal and multifocal FMD. Conclusions: Women with FMD as compared to healthy controls are characterized by hormonal alterations including lower plasma progesterone level. Taking into consideration previous findings of abnormal balance between estrogen and progesterone receptors in renal artery samples of FMD our results suggest that female hormonal disturbances may have a role in FMD development.