The neuroendocrine axis in patients with multiple sclerosis.
We investigated the basal and dynamic regulation of the hypothalamo-pituitary-adrenal (HPA), hypothalamo-pituitary-thyroid (HPT) and hypothalamo-pituitary-gonadal axes and prolactin secretion in 52 patients with clinically definite multiple sclerosis. These patients also had gadolinium enhanced brain MRI scans and were divided into relapsing-remitting, secondary progressive and primary progressive subgroups. These subgroups were compared with healthy controls and a group of patients with other neurological diseases. The cortisol diurnal rhythm was preserved in all groups of patients. The time-integrated cortisol response to human corticotropin-releasing hormone (CRH) stimulation was lower in the patients with secondary progressive multiple sclerosis, compared with patients with primary progressive multiple sclerosis and healthy subjects. The time-integrated beta-endorphin response to CRH was greater in the patients with relapsing-remitting multiple sclerosis compared with the others. Feedback regulation assessed by dexamethasone suppression was normal. Serum testosterone was low in 24% of male multiple sclerosis patients and oestradiol was low in 25% of pre-menopausal female multiple sclerosis patients, whereas prolactin and the HPT function were normal. Correlations with C-reactive protein (CRP) and MRI suggest that activation of the HPA axis in multiple sclerosis patients is secondary to an active inflammatory stimulus.
Wei
T
T
Department of Clinical Neurology, Institute of Neurology, London, UK.
Lightman
S L
SL
D000328:Adult; D000368:Aged; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D003366:Cosyntropin; D003907:Dexamethasone; D004958:Estradiol / Q000097:blood; D005221:Fatigue / Q000175:diagnosis; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D005938:Glucocorticoids; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007986:Luteinizing Hormone / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000502:physiology*; D011388:Prolactin / Q000097:blood; D013739:Testosterone / Q000097:blood; D013963:Thyroid Hormones / Q000097:blood; D013973:Thyrotropin-Releasing Hormone / Q000097:blood
D005938:Glucocorticoids; D013963:Thyroid Hormones; D003366:Cosyntropin; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D004958:Estradiol; D013973:Thyrotropin-Releasing Hormone; D003907:Dexamethasone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone