Gutiérrez M A, Garcia M E, Rodriguez J A, Rivero S, Jacobelli S
Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago.
Lupus. 1998;7(6):404-8. doi: 10.1191/096120398678920343.
The objective was to study the response of cortisol and of prolactin (PRL) to specific stimuli in systemic lupus erythematosus (SLE). We measured the response of cortisol to insulin-induced hypoglycemia and of PRL to thyrotropin releasing hormone (TRH) in seven patients with active untreated SLE and in ten paired control subjects. All were women with regular menstrual cycles. With the exception of two patients, they had never received corticosteroids before the study. The basal serum levels of cortisol (12.5+/-2.4 microg/dl) and PRL (10.7+/-1.0 ng/ml) in the SLE group were not significantly different from those of the control group (12.3+/-1.1 microg/dl and 13.7+/-2.4 ng/ml, respectively). The cortisol response after hypoglycemia was significantly lower in SLE patients compared to the control group at 45 min (P=0.01), at 60 min (P = 0.009), and at 90 min (P = 0.001). The integrated cortisol response to hypoglycemia expressed as area under the response curve (AUC) did not differ significantly in either group (1447+/-187 vs 1828+/-84, P = 0.06). Although the peak of PRL after TRH did not differ significantly in both groups (68.0+/-7.4 ng/ml in SLE vs 66.3+/-77 ng/ml in controls) and the AUC of PRL response after TRH was comparable in both groups (4672+/-537 vs 4128+/-541, P = 0.32), the interval-specific 'delta' response was significantly higher in SLE than the control group at 0-60 min (P=0.02) and 0-90 min (P = 0.01) after TRH injection. These findings suggest that active SLE is associated with some degree of dysfunction of the hypothalamic-pituitary-glucocorticoid axis and PRL secretion.
目的是研究系统性红斑狼疮（SLE）患者皮质醇和催乳素（PRL）对特定刺激的反应。我们测量了7例未经治疗的活动性SLE患者及10例配对对照受试者对胰岛素诱导的低血糖的皮质醇反应，以及对促甲状腺激素释放激素（TRH）的PRL反应。所有受试者均为月经周期规律的女性。除2例患者外，她们在研究前从未接受过皮质类固醇治疗。SLE组皮质醇的基础血清水平（12.5±2.4μg/dl）和PRL的基础血清水平（10.7±1.0ng/ml）与对照组（分别为12.3±1.1μg/dl和13.7±2.4ng/ml）相比无显著差异。低血糖后45分钟（P = 0.01）、60分钟（P = 0.009）和90分钟（P = 0.001）时，SLE患者的皮质醇反应显著低于对照组。以反应曲线下面积（AUC）表示的对低血糖的皮质醇综合反应在两组中无显著差异（1447±187 vs 1828±84，P = 0.06）。虽然两组TRH刺激后PRL的峰值无显著差异（SLE组为68.0±7.4ng/ml，对照组为66.3±7.7ng/ml），且两组TRH刺激后PRL反应的AUC相当（4672±537 vs 4128±541，P = 0.32），但TRH注射后0 - 60分钟（P = 0.02）和0 - 90分钟（P = 0.01）时，SLE组特定时间间隔的“增量”反应显著高于对照组。这些发现提示，活动性SLE与下丘脑 - 垂体 - 糖皮质激素轴及PRL分泌的某种程度功能障碍有关。
