Jorgensen C, Bressot N, Bologna C, Sany J
Department of Immunorheumatology, Hôpital Gui de Chauliac, Montpellier, France.
J Rheumatol. 1995 Oct;22(10):1829-33.
To study the dynamic response of the hypothalamo-pituitary- adrenal axis and of prolactin (PRL) pituitary secretion in rheumatoid arthritis (RA).
We performed a cortisol releasing hormone (CRH) provocation test followed by determination of adrenocorticotropin hormone (ACTH), beta-endorphin, and cortisol concentration, and then a thyrotropin releasing hormone (TRH) provocation test followed by assessment of PRL pituitary secretion in 10 patients with RA and 5 control subjects. All were women under 40 years of age. Hormone concentrations were assessed by radioimmunoassay.
Basal PRL cortisol, and ACTH concentrations were similar in patients with RA and controls. We observed a dissociation between the pituitary secretion of beta-endorphin and of ACTH in response to CRH in RA. The ACTH peak and total ACTH production (area under the curve, AUC) were similar in the 2 groups. In contrast, basal beta-endorphin was increased in RA (12.6 +/- 1.41 vs 8.29 +/- 0.144 pg/ml), and the response upregulated (AUC: 83,080 +/- 12,000 vs 54,200 +/- 2400) after CRH compared to controls (p < 0.05). Cortisol adrenal response curve was blunted, but did not reach statistical significance. In contrast, the PRL response to TRH was increased at 120 and 150 min (3461 +/- 303 vs 1897 +/- 520 muIU/ml)(p < 0.01) in patients with RA, independent of disease activity.
We observed upregulated pituitary PRL secretion in RA, and a dissociation of ACTH stress. The implication concerning the neuroendocrine system in the chronic immune response in RA is discussed.
研究类风湿关节炎（RA）患者下丘脑 - 垂体 - 肾上腺轴及垂体催乳素（PRL）分泌的动态反应。
我们对10例RA患者和5例对照受试者进行了促肾上腺皮质激素释放激素（CRH）激发试验，随后测定促肾上腺皮质激素（ACTH）、β - 内啡肽和皮质醇浓度，接着进行促甲状腺激素释放激素（TRH）激发试验，随后评估垂体PRL分泌。所有受试者均为40岁以下女性。采用放射免疫分析法评估激素浓度。
RA患者和对照组的基础PRL、皮质醇和ACTH浓度相似。我们观察到RA患者中，垂体对CRH反应时β - 内啡肽和ACTH的分泌存在分离现象。两组的ACTH峰值和ACTH总分泌量（曲线下面积，AUC）相似。相比之下，RA患者的基础β - 内啡肽升高（12.6±1.41对8.29±0.144 pg/ml），与对照组相比，CRH刺激后反应上调（AUC：83,080±12,000对54,200±2400）（p<0.05）。肾上腺皮质醇反应曲线变钝，但未达到统计学意义。相比之下，RA患者对TRH的反应在120和150分钟时升高（3461±303对1897±520 mIU/ml）（p<0.01），与疾病活动无关。
我们观察到RA患者垂体PRL分泌上调，以及ACTH应激的分离现象。讨论了神经内分泌系统在RA慢性免疫反应中的意义。
