The neuroendocrine axis in patients with multiple sclerosis

• Published in: Brain (London, England : 1878) Vol. 120; no. 6; pp. 1067 - 1076
• Main Author: Wei, T
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.06.1997; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Biological and medical sciences; Corticotropin-Releasing Hormone - blood; Cosyntropin; Dexamethasone; Estradiol - blood; Fatigue - diagnosis; Female; Follicle Stimulating Hormone - blood; Glucocorticoids; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone - blood; Hypothalamo-Hypophyseal System - physiology; Luteinizing Hormone - blood; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Multiple Sclerosis - blood; Multiple Sclerosis - diagnosis; Multiple Sclerosis - physiopathology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Pituitary-Adrenal System - physiology; Prolactin - blood; Testosterone - blood; Thyroid Hormones - blood; Thyrotropin-Releasing Hormone - blood; Human; Nervous system diseases; Multiple sclerosis; Central nervous system disease; Exploration; Biological rhythm; Inflammatory disease; Hypothalamohypophysocorticoadrenal axis; Endocrine secretion
• ISSN: 1460-2156; 0006-8950; 1460-2156
• DOI: 10.1093/brain/120.6.1067

We investigated the basal and dynamic regulation of the hypothalamo-pituitary-adrenal (HPA), hypothalamo-pituitary-thyroid (HPT) and hypothalamo-pituitary-gonadal axes and prolactin secretion in 52 patients with clinically definite multiple sclerosis. These patients also had gadolinium enhanced brain MRI scans and were divided into relapsing-remitting, secondary progressive and primary progressive subgroups. These subgroups were compared with healthy controls and a group of patients with other neurological diseases. The cortisol diurnal rhythm was preserved in all groups of patients. The time-integrated cortisol response to human corticotropin-releasing hormone (CRH) stimulation was lower in the patients with secondary progressive multiple sclerosis, compared with patients with primary progressive multiple sclerosis and healthy subjects. The time-integrated beta-endorphin response to CRH was greater in the patients with relapsing-remitting multiple sclerosis compared with the others. Feedback regulation assessed by dexamethasone suppression was normal. Serum testosterone was low in 24% of male multiple sclerosis patients and oestradiol was low in 25% of pre-menopausal female multiple sclerosis patients, whereas prolactin and the HPT function were normal. Correlations with C-reactive protein (CRP) and MRI suggest that activation of the HPA axis in multiple sclerosis patients is secondary to an active inflammatory stimulus.