Johnson Elizabeth O, Kostandi Maria, Moutsopoulos Haralampos M
Department of Anatomy-Histology-Embryology, University of Ioannina, School of Medicine, Ioannina 45-110, Greece.
Ann N Y Acad Sci. 2006 Nov;1088:41-51. doi: 10.1196/annals.1366.018.
To date, evidence suggests that rheumatic diseases are associated with hypofunctioning of the hypothalamic-pituitary-adrenal (HPA) axis. Sjögren's syndrome (SS), the second most common autoimmune disorder, is characterized by diminished lacrimal and salivary gland secretion. To examine HPA axis activity in SS patients, the adrenocorticotropin (ACTH) response to ovine corticotropin-releasing factor (oCRH) was used as a direct measure of corticotrophic function, and the plasma cortisol response to the ACTH released during oCRH stimulation as an indirect measure of adrenal function. Significantly lower basal ACTH and cortisol levels were found in patients with SS and were associated with a blunted pituitary and adrenal response to oCRH compared to normal controls. Fibromyalgia (FM) patients demonstrated elevated evening basal ACTH and cortisol levels and a somewhat exaggerated peak, delta, and net integrated ACTH response to oCRH. A subgroup of SS patients also met the diagnostic criteria for FM and demonstrated a pituitary-adrenal response that was intermediate to SS and FM. These findings suggest not only adrenal axis hypoactivity in SS and FM patients, but also that varying patterns of adrenal and thyroid axes dysfunction may exist in patients with different rheumatic diseases.
迄今为止，有证据表明风湿性疾病与下丘脑 - 垂体 - 肾上腺（HPA）轴功能减退有关。干燥综合征（SS）是第二常见的自身免疫性疾病，其特征是泪腺和唾液腺分泌减少。为了检测SS患者的HPA轴活性，将促肾上腺皮质激素（ACTH）对羊促肾上腺皮质激素释放因子（oCRH）的反应作为促肾上腺皮质功能的直接指标，将oCRH刺激期间释放的ACTH所引起的血浆皮质醇反应作为肾上腺功能的间接指标。与正常对照组相比，SS患者的基础ACTH和皮质醇水平显著降低，且与垂体和肾上腺对oCRH的反应迟钝有关。纤维肌痛（FM）患者的夜间基础ACTH和皮质醇水平升高，对oCRH的峰值、增量和净综合ACTH反应有所夸大。一部分SS患者也符合FM的诊断标准，其垂体 - 肾上腺反应介于SS和FM之间。这些发现不仅表明SS和FM患者存在肾上腺轴功能减退，还表明不同风湿性疾病患者可能存在肾上腺和甲状腺轴功能障碍的不同模式。
