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The hypothalamic-pituitary-adrenocortical and gonadal axis function in rheumatoid arthritis
M Cutolo1, M Giusti, L Foppiani
1Division of Rheumatology, Department of Internal Medicine, University of Genova-Italy, Viale Benedetto XV, 6 I-16132 Genova, Italy.
Zeitschrift Fur Rheumatologie
|January 13, 2001
Summary
Rheumatoid arthritis (RA) patients exhibit relative adrenal insufficiency due to inflammation. Hormonal imbalances in cortisol, androgens, and sex steroids impact RA pathophysiology and immune responses.
Area of Science:
- Endocrinology
- Immunology
- Rheumatology
Background:
- Rheumatoid arthritis (RA) is associated with altered endocrine function, particularly involving the hypothalamic-pituitary-adrenal (HPA) and gonadal axes.
- Inflammatory processes in RA, indicated by elevated Interleukin-6 (IL-6), contribute to a state of relative adrenal insufficiency.
- Sex hormones, including androgens and estrogens, play a role in immune regulation and may influence RA susceptibility and progression.
Purpose of the Study:
- To investigate the relationship between adrenal and gonadal hormone secretion and the inflammatory state in rheumatoid arthritis.
- To explore the potential role of hormonal dysregulation in the pathophysiology and immune dysfunctions observed in RA patients.
Main Methods:
- Assessment of cortisol and dehydroepiandrosterone sulfate (DHEAS) secretion in RA patients not receiving corticosteroids.
- Correlation of hormone levels with inflammatory markers such as serum IL-6.
- Review of existing data on testosterone, estrogen, and progesterone levels in RA patients, considering gender and menopausal status.
Main Results:
- RA patients demonstrate altered cortisol and DHEAS secretion, indicative of relative adrenal insufficiency in the context of sustained inflammation.
- Low plasma testosterone levels are found in male RA patients, while low DHEAS levels are more prevalent in female RA patients.
- Evidence suggests a role for sex steroid deficiency, potentially linked to menopausal changes, in RA pathogenesis, influencing immune responses.
Conclusions:
- A complex interplay between the HPA axis and gonadal axis functions is evident in rheumatoid arthritis.
- Hormonal imbalances, including androgens and sex steroids, are implicated in the autoimmune processes and immune dysregulation characteristic of RA.
- Further research into steroidogenesis gene polymorphisms and acquired metabolic changes is warranted to fully elucidate the role of hormones in RA.