Adrenal androgen and glucocorticoid dissociation in premenopausal onset rheumatoid arthritis: A clue to it's physiopathogenesis?

Journal/Book: Z Rheumatol 1999; 58: 300-302. 1999;

Abstract: A. T. Masi; College of Medicine at Peoria Department of Medicine University of Illinois at Chicago In 1967 we began investigations of endocrine-metabolic alterations in rheumatoid arthritis (RA) as part of a multidisciplinary NIH grant (1). A conjoint clinical research center (CRC) protocol was also started at that time (2). Those early studies on hypothalamic-pituitary-adrenal (HPA) function in 10 (9 F 1 M) RA patients (8 premenopausal women) not previously treated with either glucocorticoids or second-line drugs and 10 matched healthy controls (CN). Details of the CRC protocol and the adrenal androgen (AA) results were published (3). In 1978 one of us (ATM) moved to his current university. Prospective studies began of adrenal steroids in premenopausal women who developed RA before age 50 and matched CN. This presentation summarizes plasma cortisol results from the early CRC protocol as well as serum cortisol and DHEAS findings from the prospective study. The CRC protocol include three tests of hypothalamic-pituitary-adrenal-glucocorticoid (HPA-G) axis function although plasma ACTH assays were not performed. I. Continous 8-hour ACTH (50 i.v.) infusion test: Plasma cortisol levels (µg/dl) were determined prior to initiating ACTH infusion at 08:00 and at five subsequent samplings until 16:00. The intervals were at log base 2 timings i.e. : 1/2 1 2 4 and 8-hours post-infusion. One of us (ATM) observed that a linear function was closely approximated to the cortisol levels at such log intervals. Therefore the "slopes (b)" of the regression lines of individual ACTH tests could be used as single-value indicators of glucocorticoid responsiveness to this stimulation test (4). ... le

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