Infusion of epinephrine decreases serum levels of cortisol and 17-hydroxyprogesterone in patients with rheumatoid arthritis.
OBJECTIVE
To investigate the pituitary and adrenal hormone response after an intravenous epinephrine challenge in patients with rheumatoid arthritis (RA) and controls.


METHODS
Fifteen untreated female patients with RA (age 51.5 +/- 3.2 yrs) and 7 healthy female controls (48.0 +/- 4.3 yrs) were infused with epinephrine (0.05 microg/kg/min) for about 20 min. Plasma levels of adrenocorticotropic hormone (ACTH), and serum levels of cortisol, 17-hydroxyprogesterone (17OHP), and dehydroepiandrosterone sulfate (DHEAS) were analyzed at baseline and shortly after cessation of epinephrine infusion (20 min).


RESULTS
At baseline and after epinephrine infusion, serum levels of cortisol (p = 0.045) and 17OHP (p = 0.021) were higher in controls compared to patients with RA. In contrast, at baseline and after epinephrine infusion, plasma levels of ACTH and serum levels of DHEAS were similar in controls and patients. After epinephrine infusion, only the patients with RA had a significant decrease of serum cortisol (p = 0.026) and serum 17OHP (p = 0.026). Plasma levels of ACTH (p = 0.073) and serum levels of DHEAS (p = 0.055) tended to decrease.


CONCLUSIONS
Serum cortisol and 17OHP (cortisol precursor) were lower in patients with RA compared to controls despite similar ACTH levels. Simulation of an adrenomedullary stress response by epinephrine infusion decreased serum cortisol and 17OHP in patients but not in controls. Such a response may play an unfavorable role during a typical stress reaction in patients with RA that may lead to a more proinflammatory situation.
Department of Internal Medicine I, University Medical Center Regensburg, Germany. rainer.straub@klinik.uni-regensburg.de
Rainer H
RH
Straub
Jens M
JM
Kittner
Cobi
C
Heijnen
Manfred
M
Schedlowski
Reinhold E
RE
Schmidt
Roland
R
Jacobs
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000502:physiology; D007262:Infusions, Intravenous; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000502:physiology; D013566:Sympathomimetics / Q000008:administration & dosage / Q000494:pharmacology*
D013566:Sympathomimetics; D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D004837:Epinephrine