title: Low-dose glucocorticoid therapy complements the pituitary-adrenocortical system and reduces anxiety and insomnia in myasthenia gravis patients.
abstract: Myasthenia gravis (MG) is an autoimmune disorder generally mediated by antibodies against the acetylcholine receptors of the skeletal muscles. Depending on the disease burden, MG patients may experience chronic dysregulation of both the hormonal stress axis and the immune system, consequently, aggravating the disease itself but also leading to secondary psychopathological abnormalities. A long-term clinical course requires long-term glucocorticoid (GC) therapy, which may change the psychological state by affecting the pituitary-adrenocortical system in MG patients. In this study, we investigated the function of the pituitary-adrenocortical system in MG patients who were treated with prednisolone (PSL) and evaluated their quality of life by using the Medical Outcomes Study 36-item Short-Form Health Survey and the 28-item general health questionnaire (GHQ-28). ACTH and cortisol levels in the plasma of patients who were treated with PSL (PSL[+] group, n = 18) were lower than those in the plasma of patients who were treated without PSL (PSL[-] group, n = 29; P < 0.05 and P < 0.01, respectively). In the PSL(+) group, we confirmed that cortisol levels negatively correlated with daily PSL dosages (P < 0.05). The anxiety and depression scores from the GHQ-28 in the PSL(+) group were lower than those in the PSL(-) group (P < 0.05, respectively). There was no significant correlation between cortisol levels and corticotropin levels in plasma of the PSL(-) group. However, we confirmed that corticotropin levels positively correlated with cortisol levels in plasma (P < 0.01) and negatively correlated with anxiety/insomnia scores from the GHQ-28 (P < 0.05) in the PSL(+) group. In conclusion, low-dose GC treatment complemented the pituitary-adrenocortical system and improved the psychological state in MG patients.
authors.affiliation: Third Department of Internal Medicine, Tokyo Medical University, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Ito
authors.forename: Masayuki
authors.initials: M
authors.lastname: Masuda
authors.forename: Sachiko
authors.initials: S
authors.lastname: Tanaka
authors.forename: Miwa
authors.initials: M
authors.lastname: Takagi
authors.forename: Chinami
authors.initials: C
authors.lastname: Tanaka
authors.forename: Nao
authors.initials: N
authors.lastname: Yamada
authors.forename: Kanako
authors.initials: K
authors.lastname: Nakajima
authors.forename: Takao
authors.initials: T
authors.lastname: Akashi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Hirano
authors.forename: Hiroya
authors.initials: H
authors.lastname: Utsumi
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000188:drug therapy* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000097:blood / Q000150:complications / Q000188:drug therapy; D011239:Prednisolone / Q000097:blood / Q000627:therapeutic use*; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000209:etiology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D006854:Hydrocortisone