title: Plasma cortisol level in amyotrophic lateral sclerosis.
abstract: BACKGROUND
  Amyotrophic Lateral sclerosis (ALS) is associated with a significant distress, being linked to changes in hypothalamic-pituitary-adrenal axis activity. A loss of cortisol circadian rhythmicity in ALS patients was suggested,while more recently an increased plasma cortisol level in the disease has been reported.
  
  
  OBJECTIVE
  To assay the circadian plasma cortisol level in ALS and to study its relationship with the clinical phenotype and the rate of disease progression.
  
  
  METHODS
  135 ALS patients (Bulbar, 33; Spinal, 102;M/F=1.73) and 110 controls (not affected by neurological or psychiatric disorders, free of drugs; M/F=1.75) were recruited. Disease progression was scored with ΔFS.Morning and evening plasma cortisol levels (μg/dl)were assayed from fasting ALS patients and controls using Elecsys® Cortisol Immunoassay System.
  
  
  RESULTS
  We found that the morning level of cortisol in ALS patients was higher than controls (morning: ALS, 15.2[11.5-18.9] vs Controls, 11.4 [8.8 -14.3], p b 0.001; evening: ALS, 7.5[4.7–11.8] vs Controls, 7.9[5.4–10.0], p=0.6).Furthermore, the hormone's level was higher in the spinal-onset group (Spinal, 15.9[11.9–19.0] vs Bulbar,13.5[10.1–18.6] vs controls, 11.4[8.8–14.3], p b 0.001) and in patients with intermediate/rapid disease course.
  
  
  CONCLUSIONS
  Morning plasma cortisol level is increased in ALS, mainly in spinal-onset patients and in those with intermediate/rapidly progressing disease. The plasmatic changes of the steroid hormone appear however too small to make it a sensitive biochemical marker in this severe neurodegenerative disease.
authors.affiliation: ALS Clinical Research Centre, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, 90129 Palermo, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Spataro
authors.affiliation: Neurorehabilitation Unit, ALS Center, S Maugeri Foundation, Mistretta, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Volanti
authors.affiliation: Dept of Sciences for Health Promotion, University of Palermo, 90127 Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vitale
authors.affiliation: Dept of Sciences for Health Promotion, University of Palermo, 90127 Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meli
authors.affiliation: ALS Clinical Research Centre, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, 90129 Palermo, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Colletti
authors.affiliation: Neurorehabilitation Unit, ALS Center, S Maugeri Foundation, Mistretta, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Natale
authors.affiliation: ALS Clinical Research Centre, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of Palermo, 90129 Palermo, Italy. Electronic address: vincenzo.labella@unipa.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: La Bella
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002940:Circadian Rhythm; D018450:Disease Progression; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone
keywords: ALS; ALSFRS-R; Biomarker; Cortisol; Disease progression