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The neuroendocrine axis in patients with multiple sclerosis
1Department of Clinical Neurology, Institute of Neurology, London, UK.
Brain : a Journal of Neurology
|June 1, 1997
Summary
Multiple sclerosis patients show altered hypothalamo-pituitary-adrenal (HPA) axis responses, particularly in secondary progressive MS. HPA axis activation appears linked to active inflammation in multiple sclerosis.
Area of Science:
- Neuroendocrinology
- Immunology
- Neurology
Background:
- The hypothalamo-pituitary-adrenal (HPA), HPT, and HPG axes regulate stress response and homeostasis.
- Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system.
- Endocrine dysregulation may contribute to MS pathogenesis and progression.
Purpose of the Study:
- To investigate the regulation of the HPA, HPT, and HPG axes and prolactin secretion in MS patients.
- To compare endocrine function across different MS subtypes (relapsing-remitting, secondary progressive, primary progressive) and controls.
- To explore correlations between endocrine function, MRI findings, and inflammatory markers in MS.
Main Methods:
- Studied 52 patients with clinically definite MS and healthy/other neurological disease controls.
- Assessed basal and dynamic regulation of HPA, HPT, and HPG axes and prolactin secretion.
- Utilized human corticotropin-releasing hormone (CRH) stimulation tests and dexamethasone suppression tests.
- Correlated endocrine data with gadolinium-enhanced brain MRI and C-reactive protein (CRP) levels.
Main Results:
- Cortisol diurnal rhythm was preserved in all MS groups.
- Lower time-integrated cortisol response to CRH in secondary progressive MS vs. primary progressive MS and controls.
- Greater time-integrated beta-endorphin response to CRH in relapsing-remitting MS.
- Normal dexamethasone suppression tests, indicating intact feedback regulation.
- Hypogonadism (low testosterone/estradiol) observed in 24% of males and 25% of pre-menopausal females with MS.
- Normal prolactin levels and HPT function.
Conclusions:
- HPA axis activation in MS patients is likely secondary to active inflammatory stimuli.
- Specific alterations in HPA axis dynamics are associated with different MS disease courses.
- Subclinical hypogonadism is prevalent in MS patients.
- Endocrine assessment provides insights into MS pathophysiology and disease activity.