Clinical and radiographic features of sarcoidosis in menopausal women: The impact on therapeutic approach and prognosis

Abstract

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. The aim of the study was to determine are there significant differences in clinical manifestations, radiographic and lung function findings and therapeutic approach in menopausal female sarcoidosis pa-tients compared to premenopausal ones. Seventy seven Caucasian women (average age 43.71 years, range 38-54) with sarcoidosis diagnosed at the University Hospital from January to October 2006, were included in the study. They were divided into two groups according to their menstrual period status. The group I included 42 women with normal menstrual cycle, while the group II included 35 menopausal women (either spontaneous or after hysterectomy). The patients were not under hormonal therapy. We found significantly higher proportion of the first radiographic stage (66.7% vs 34.2%, p < 0.05) and acute form of sarcoidosis (57.2% vs 17.1%; p < 0.01) in the group I in relation to the group II. Extrapulmonary sarcoidosis was more frequent in the group II than in the group I (p < 0.01). Disturbances of lung ventilation were registered in 50.8% of all the patients, and decrease of one or both of diffusion parameters was found in 63.6%, but without significant differences between the groups (p > 0.05). Hypercalciuria was found in 19.1% of the patients in the group I and 42.8% of the patient in the group II (p < 0.05). A difference in the therapy approach was also found to be significant with methotrexate more frequently applied in the group II than in the group I (p < 0.01). Menopausal women with sarcoidosis may represent a group of patients that requires special attention in diagnostic procedure, therapeutic approach and follow-up, to prevent unfavourable course of the disease. Attention should be particularly focused on the detection of extrapulmonary sites involvement in this group of the patients. Further prospective studies are needed to reveal the role of hormones, and especially plasma estrogen level in sarcoidosis appearance.