ODP266 Deficiency of Calcitriol and Sex Hormones, Which Leads to a Severe Course of Psoriasis

Abstract

Abstract Materials and methods The study group consisted of 17 patients with psoriasis from 19 to 76 years. All patients underwent studies to determine the body's vitamin D supply by its metabolite calcidiol 25(OH)D by enzyme immunoassay and to determine the level of steroid hormones by the steroid profile of saliva by mass spectrometry: progesterone, testosterone, estradiol. Results Vitamin D insufficiency was detected in 9 patients (n=9, 52.9%), the average level was 24.3±0.96 ng/ml. Vitamin D deficiency was observed in 3 patients (n=3, 17.7%), the average level was 16.6±1.634 ng/ml. Adequate vitamin D levels was detected in 5 patients (n=5, 29.4%), the average level was 34.56±1.955 ng/ml. In all patients (n=17, 100%), psoriasis was in a progressive stage, PASI more than 20 points – severe psoriasis. When evaluating the steroid profile of saliva in 7 patients (n=7, 41.2%) the level of progesterone was below the reference values (reference values 80-180 pg/ml), average level 56.86±6.53 pg/ml. In 11 patients (n=11, 64.7%), including 7 patients with progesterone deficiency plus 4 patients whose progesterone levels are within the reference values, have the level of testosterone was below the reference values (reference values from 114.8 pg/ml) the average level 51.93±9.5 pg/ml. Discussion Considering steroidogenesis [1], even though only 4 (n=4, 23.5%) patients had estradiol levels below reference values (reference values 4.17-9.28 pg/ml), we conclude that estradiol deficiency was observed in at least 11 patients (n=11, 64.7%). Also, knowing the effect of vitamin D on steroidogenesis (increases the expression of the 3b-HSD gene, thereby increasing progesterone synthesis [2]), thus we already know that if a patient is vitamin D insufficient or deficient, even when within the reference values, progesterone levels will not be sufficient for this individual, and therefore there will be testosterone and estradiol deficiency. It follows that another 8 patients with vitamin D insufficiency or deficiency will have progesterone deficiency, that is, out of 17 patients, 15 (n=15, 88.2%) have progesterone deficiency and, therefore, testosterone and estradiol deficiency. In enzyme immunoassay vitamin D determination, a cross-reaction occurs with another metabolite - 24.25(OH)D, whose concentration is up to 20% of the total calcidiol concentration. Therefore, it is necessary to subtract up to 20% from the data obtained in order to determine the true level of 25(OH)D [3], which means that all patients have vitamin D deficiency. Estrogens enhance the synthesis and effects of 1,25(OH)D, through an increase in the expression of the CYP27B1 (1α-hydroxylase) gene and VDR [4]. Conclusion The sufficient intake of vitamin D and a sufficient level of calcidiol, the intensity of the synthesis of the hormonal form of vitamin D and the realization of its effects depend on several factors, which include a sufficient level of sex hormones. Presentation: No date and time listed