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Hypothalamo-pituitary-adrenal axis activity evolves differentially in untreated versus treated multiple sclerosis
Tania Kümpfel1, Michaela Schwan1, Frank Weber1
1Max Planck Institute of Psychiatry, Section of Neurology, Kraepelinstrasse 10, 80804 München, Germany.
Psychoneuroendocrinology
|May 22, 2014
Summary
In multiple sclerosis (MS), untreated patients show HPA axis shifts towards adrenal activation over time. Disease-modifying treatments (DMT) help stabilize hypothalamo-pituitary-adrenal (HPA) system regulation in MS patients.
Area of Science:
- Neuroendocrinology
- Multiple Sclerosis Pathophysiology
- HPA Axis Function
Background:
- Multiple sclerosis (MS) is associated with heterogeneous hypothalamo-pituitary-adrenal (HPA) system dysregulation.
- Cross-sectional studies suggest increasing HPA axis hyperactivity with disease progression in MS.
- Longitudinal data on HPA axis evolution and the impact of disease-modifying treatments (DMT) in MS are lacking.
Purpose of the Study:
- To investigate the longitudinal changes in HPA system activity in patients with definite MS.
- To assess the influence of disease-modifying treatments (DMT) on HPA axis regulation over time.
- To analyze neuroendocrine indicators including cortisol, ACTH, and their ratios.
Main Methods:
- An open follow-up study of sixty MS patients was conducted.
- The combined dexamethasone/CRH test was administered at baseline and follow-up.
- Neuroendocrine indicators (maximum, maximum rise, mean location, area under the curve) for cortisol, ACTH, and ACTH/cortisol ratio were derived.
Main Results:
- Untreated patients (n=20) showed a significant decrease in ACTH/cortisol ratios, with mild cortisol increase and ACTH reduction.
- Patients on DMT (n=40) exhibited no significant changes in cortisol, ACTH, or ACTH/cortisol ratios.
- A moderate correlation was found between baseline and follow-up cortisol levels, but not for ACTH indicators.
Conclusions:
- HPA axis activation in untreated MS shifts from hypothalamo-pituitary to adrenal activation, suggesting adrenal sensitization.
- HPA system regulation remains more stable in MS patients receiving DMT.
- DMT may play a role in maintaining HPA axis stability during MS progression.
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