Fatigue and regulation of the hypothalamo-pituitary-adrenal axis in multiple sclerosis.
BACKGROUND
Fatigue is a common and disabling symptom in patients with multiple sclerosis (MS). Underlying mechanisms postulated so far have involved localization of brain lesions and abnormalities of the neuroendocrine system and cytokine regulation.


OBJECTIVE
To investigate the relationship between fatigue and the hypothalamo-pituitary-adrenal (HPA) axis in patients with MS.


METHODS
A prospective survey.


METHODS
Outpatient and inpatient study at the Max Planck Institute of Psychiatry, Munich, Germany.


METHODS
Thirty-one patients with clinically definite MS, a relapsing-remitting disease course, and without MS-specific treatment.


METHODS
Assessment of fatigue with 3 questionnaires: the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS), and the Visual Analog Scale. Assessment of HPA axis regulation with the combined dexamethasone-corticotropin releasing hormone (Dex-CRH) test.


RESULTS
The FSS score was significantly correlated with the MFIS score. Patients with fatigue had significantly elevated adrenocorticotropin (ACTH) levels in the combined Dex-CRH test.


CONCLUSIONS
In contrast to results for chronic fatigue syndrome, where a hyporeactivity of the HPA axis has been shown, MS patients with fatigue exhibited a higher activity of the HPA axis than those without fatigue, as evidenced by significantly increased ACTH concentrations. Proinflammatory cytokines, known to be elevated in patients with MS, may cause both HPA axis alterations and fatigue.
Gottschalk
Michaela
M
Max Planck Institute of Psychiatry, Munich, Germany.
Kümpfel
Tania
T
Flachenecker
Peter
P
Uhr
Manfred
M
Trenkwalder
Claudia
C
Holsboer
Florian
F
Weber
Frank
F
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D003907:Dexamethasone / Q000097:blood; D004185:Disability Evaluation; D005221:Fatigue / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D008297:Male; D009103:Multiple Sclerosis / Q000378:metabolism / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone