title: Fatigue in progressive multiple sclerosis is associated with low levels of dehydroepiandrosterone.
abstract: OBJECTIVE
  Fatigue is one of the most limiting symptoms in multiple sclerosis (MS) and the mechanisms underlying its origin are poorly understood. Our aim was to test whether fatigue in MS is associated with endocrine markers.
  
  
  METHODS
  We longitudinally studied 73 progressive MS patients. Fatigue was assessed at baseline and at 3, 6, 12 and 24 months using the Fatigue Severity Scale (FSS). Given the longitudinal design of our study, patients were labelled as sustained fatigued when FSS scores were >5.0 at all time points, and as non-fatigued when FSS scores were < or = 5.0 at all time points. Serum levels of dehydroepiandrosterone (DHEA), its sulphated conjugate (DHEAS) and cortisol were measured at each time point.
  
  
  RESULTS
  Twenty-nine patients scored >5.0 in the FSS at all time points, and 9 patients (12.3%) scored 5.0 at all time points. Mean baseline levels of DHEAS and DHEA were lower in MS patients with sustained fatigue when compared to patients without fatigue (P = 0.01 and P = 0.03 respectively). Analysis of DHEAS and DHEA over time showed significantly lower hormone levels in patients with fatigue [F(1,31) = 6.14, P=0.019 for DHEAS; F(1,32) = 6.63, P=0.015 for DHEA].
  
  
  CONCLUSIONS
  Fatigue in progressive MS could be related to low serum levels of DHEA and DHEAS. Our results suggest that these hormones should be considered as biological markers of fatigue in MS patients and that hormone replacement may thus be tested as an option to treat fatigue in MS patients.
authors.affiliation: Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain. ntellez@vhebron.net
authors.forename: Nieves
authors.initials: N
authors.lastname: Téllez
authors.forename: Manuel
authors.initials: M
authors.lastname: Comabella
authors.forename: Eva
authors.initials: E
authors.lastname: Julià
authors.forename: Jordi
authors.initials: J
authors.lastname: Río
authors.forename: Mar
authors.initials: M
authors.lastname: Tintoré
authors.forename: Luís
authors.initials: L
authors.lastname: Brieva
authors.forename: Carlos
authors.initials: C
authors.lastname: Nos
authors.forename: Xavier
authors.initials: X
authors.lastname: Montalban
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D003687:Dehydroepiandrosterone / Q000097:blood*; D004703:Endocrine System / Q000378:metabolism; D005221:Fatigue / Q000097:blood* / Q000209:etiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000097:blood* / Q000150:complications*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D003687:Dehydroepiandrosterone; D006854:Hydrocortisone