A Pilot Study on the Co-existence of Diabetes and Endometriosis in Reproductive-Age Women: Potential for Endometriosis Progression

Iad Alhallak, Charles M Quick, Garrett L Graham, Rosalia C. M. Simmen
Reproductive sciences (Thousand Oaks, Calif.) · 2023 · vol. 30(8) , pp. 2429–2438 · doi:10.1007/s43032-023-01190-3 · PMID:36788175 · W4320855855
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This pilot study found that women with both endometriosis and diabetes exhibited altered steroid hormone receptor levels in their lesions, suggesting a potential for endometriosis progression.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This pilot study used archived formalin-fixed paraffin-embedded ectopic endometriosis lesions from reproductive-age women identified in an electronic health record repository to compare women without diabetes (ENDO-N, n=11) versus those with diabetes co-morbidity (ENDO-DM, combined T1DM/T2DM, n=15). The investigators performed immunohistochemistry to quantify proliferation and immune infiltration (Ki67, PTEN, CD68) and steroid receptor signaling (ESR1, ESR2, PGR-T), reporting nuclear versus stromal/epithelial compartment-specific staining as percentages of positive cells; key findings were that ENDO-DM lesions showed higher stromal nuclear ESR2 and lower stromal PGR-T, with altered stromal and epithelial ESR1/ESR2 and stromal CD68 patterns consistent with changes in hormone receptor levels. The authors note major caveats including small sample sizes, combining T1DM and T2DM due to limited numbers, and missing data such as duration of progestin use. This paper is centrally about endometriosis — it examines how co-existing diabetes affects immune and steroid-hormone receptor markers in endometriosis lesions, suggesting diabetes-associated endometriosis progression.

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Abstract

Endometriosis (ENDO) is a chronic estrogen-dependent gynecological condition that affects reproductive-age women, causing pelvic pain, infertility, and increased risk for ovarian cancer. Diabetes mellitus (DM) is a metabolic disease with significant morbidity and mortality and rising incidence worldwide. The occurrence of DM among ENDO patients remains understudied, despite commonalities in these conditions' immune, inflammatory, and metabolic dysfunctions. This pilot study evaluated whether a subset of women with ENDO manifests DM co-morbidity and if so, whether DM promotes ENDO status. Archived ectopic lesions obtained at ENDO surgery from non-diabetic (ENDO-N; n = 11) and diabetic (ENDO-DM; n = 15) patients were identified by a search of an electronic health database. Retrieved samples were analyzed by immunohistochemistry for markers of proliferation (Ki67, PTEN), steroid receptor signaling (ESR, PGR) and macrophage infiltration (CD68). Immunostaining data were expressed as percentages of immune-positive cells in lesion stroma and epithelium. In lesion stroma, the percentages of nuclear immune-positive cells were higher for ESR2 and lower for PGR-T, in ENDO-DM than ENDO-N patients. The percentages of nuclear immune-positive cells for ESR1 and PTEN tended to be higher and lower, respectively, in ENDO-DM than ENDO-N groups. In lesion glandular epithelium, the percentages of nuclear immune-positive cells were higher for ESR1 and ESR2, in ENDO-DM than ENDO-N groups. ENDO-N lesions had lower percentages of stromal CD68 immune-positive cells than ENDO-DM Type 1 lesions. Findings demonstrate DM in a subset of women with ENDO, which was associated with significant changes in lesion stromal and epithelial nuclear steroid hormone receptor levels, suggestive of disease progression.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus

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