Adolescents with autism spectrum disorders premenstruel dysphoric disorder prevalence, allopregnenolone-progesterone-estrogen seruminvestigation of levels and related factors

Objective: Premenstrual dysphoric disorder (PMDD) is a common cyclic disorder characterized by somatic, cognitive, emotional and behavioral symptoms that lasts throughout the luteal phase of the menstrual cycle and ends with the onset of menstruation. The pathophysiology of PMDD is not yet fully understood, but a relationship has been found with circulating gonadal steroid hormones, especially allopregnenolone, produced by the corpus luteum after ovulation. The main purpose of our study is to investigate the prevalence of Premenstrual Dysphoric Disorder and serum levels of estradiol, progesterone, pregnenalone, allopregnenolone in adolescents with Autism Spectrum Disorder. The data and findings to be obtained as a result of this research will be a guide in elucidating the etiopathogenesis of ASD and PMDD. In addition, it will be instrumental in making appropriate interventions by increasing the awareness of the symptoms related to PMDD in individuals with ASD. Material and methods: 35 female adolescents with autism between the ages of 12-18 who applied to the outpatient clinic of Istanbul University, Istanbul Faculty of Medicine, Department of Child and Adolescent Psychiatry and met the exclusion and inclusion criteria were included in the study. After the psychiatric evaluation based on DSM V, the Socio-demographic data form and the Childhood Autism Rating Scale were filled by the parents. In addition, the Aberrant Behavior Checklist (ABC) and Premenstrual Assessment Form were filled by the parents twice, in luteal and follicular phases. Approximately 5-8 ml of venous blood was taken from the sample. Serum samples were evaluated by ELISA method and allopregnanolone, estradiol, progesterone and pregnenolone levels were determined. Results: 60% of the cases diagnosed with ASD in our study were diagnosed with PMDD in psychiatric evaluation based on DSM V. The severity of ASD (p = 0.022), retardation in self-care skills (p = 0.022) and the presence of mental disability (p = 0.039) were found to be higher in the PMDD group compared to the non-PMDD group. Again, it was found that problem behaviors determined by ABC increased in the luteal phase compared to the follicular phase, especially in the PMDD group (p <0.05). When serum estradiol, progesterone, pregnenalone and allopregnenalone levels were examined, estradiol was significantly higher (z = -2.088, p = 0.037), and progesterone and allopregnenalone levels were significantly lower in the PMDB group compared to the non-PMDB group (z = -2.458, p = 0.013. z = -2.610, p = 0.008, respectively). In terms of serum pregnenolone levels, no significant difference was found between the group with PMDD and the group without PMDB (z = -1.785, p = 0.077). Conclusions: The prevalence of PMDD in children with ASD was detected as high as 60%. An increase in problem behaviors in the luteal phase of the menstrual cycle is one of the important findings of our study. We think that our results related to gonadal steroid hormones that may be associated with PMDD in individuals with autism may provide important data regarding the etiology of PMDD in these individuals. Further studies are needed to examine the effectiveness of psychosocial, psychotherapeutic and psychopharmacological approaches to these problems, which greatly impair the quality of life of these individuals and their families. KEY WORDS: ASD, PMDD, adolescent, allopregnanolone, estradiol, progesterone and pregnenolone