Gutiérrez M A, García M E, Rodriguez J A, Mardonez G, Jacobelli S, Rivero S
Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago.
J Rheumatol. 1999 Feb;26(2):277-81.
To study the response of cortisol and of prolactin (PRL) to specific stimuli in rheumatoid arthritis (RA).
We measured the response of cortisol to insulin induced hypoglycemia and of PRL to thyrotropin releasing hormone (TRH) in 10 patients with active RA and in 10 paired control subjects. All were women with regular menstrual cycles. They had never received corticosteroids before the study. The PRL concentration was assessed by chemiluminescence immune assay and the cortisol concentration by radioimmunoassay.
The basal serum levels of cortisol (14.47+/-2.5 microg/dl) and PRL (10.1+/-1.3 ng/ml) in the RA 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 peak value of cortisol after hypoglycemia was comparable in both groups (25.5+/-2.4 microg/dl in RA vs. 26.0+/-1.5 ng/ml in controls). The integrated cortisol response to hypoglycemia expressed as area under the response curve (AUC) did not differ significantly in either group (1927+/-196 in RA vs. 1828+/-84 in controls). The interval-specific "delta" cortisol response was significantly higher for the 30 to 45 min interval in controls compared to patients with RA (9.8+/-0.9 microg/dl vs. 6.1+/-1.1 microg/dl; p = 0.02). The peak of PRL after TRH did not differ significantly in both groups (56.4+/-6.4 ng/ml in RA vs. 66.3+/-7.7 ng/ml in controls) and the AUC of PRL secretion after TRH was comparable in both groups (3245+/-321 vs. 4128+/-541).
Our findings suggest that active RA is associated with subtle dysfunction of the hypothalamic-pituitary-adrenal glucocorticoid function and normal PRL secretion.
研究类风湿关节炎（RA）患者皮质醇和催乳素（PRL）对特定刺激的反应。
我们测量了10例活动期RA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和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。在研究前她们从未接受过皮质类固醇治疗。PRL浓度通过化学发光免疫分析法评估，皮质醇浓度通过放射免疫分析法评估。
RA组皮质醇基础血清水平（14.47±2.5μg/dl）和PRL基础血清水平（10.1±1.3ng/ml）与对照组（分别为12.3±1.1μg/dl和13.7±2.4ng/ml）无显著差异。低血糖后皮质醇峰值在两组中相当（RA组为25.5±2.4μg/dl，对照组为26.0±1.5ng/ml）。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（RA组为1927±196，对照组为1828±84）。与RA患者相比，对照组在30至45分钟间隔的特定间隔“δ”皮质醇反应显著更高（9.8±0.9μg/dl对6.1±1.1μg/dl；p = 0.02）。TRH刺激后PRL峰值在两组中无显著差异（RA组为56.4±6.4ng/ml，对照组为66.3±7.7ng/ml），TRH刺激后PRL分泌的AUC在两组中相当（3245±321对4128±541）。
我们的研究结果表明，活动期RA与下丘脑 - 垂体 - 肾上腺糖皮质激素功能的细微功能障碍及正常PRL分泌有关。
