Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

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Ann Rheum Dis. 2004 Jun;63(6):671-4.

Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis.

Imrich R, Rovensky J, Zlnay M, Radikova Z, Macho L, Vigas M, Koska J.

Institute of Experimental Endocrinology, Slovak Academy of Sciences,

Vlarska 3, 833 06 Bratislava, Slovakia. richard.imrich@...

OBJECTIVE: To assess basal function and responsiveness of the

hypothalamic-pituitary-adrenal (HPA) axis in patients with ankylosing

spondylitis during dynamic testing. METHODS: Insulin induced

hypoglycaemia (IIH) (Actrapid HM 0.1 IU/kg, as intravenous bolus) was

induced in 17 patients and 11 healthy controls matched for age, sex, and

body mass index. Concentrations of glucose, adrenocorticotrophic hormone

(ACTH), cortisol, insulin, dehydroepiandrosterone sulphate (DHEAS),

17alpha-hydroxyprogesterone, interleukin 6 (IL-6), and tumour necrosis

factor alpha (TNFalpha) were determined in plasma. RESULTS: Comparable

basal cortisol levels were found in the two groups, with a trend to be

lower in ankylosing spondylitis. In the ankylosing spondylitis group,

there were higher concentrations of IL-6 (mean (SEM): 16.6 (2.8) pg/ml v

1.41 (0.66) pg/ml in controls; p<0.001) and TNFalpha (8.5 (1.74) pg/ml v

4.08 (0.42) pg/ml in controls; p<0.01). Glucose, insulin, ACTH, DHEAS,

and 17alpha-hydroxyprogesterone did not differ significantly from

control. The IIH test was carried out successfully in 11 of the 17

patients with ankylosing spondylitis, and the ACTH and cortisol

responses were comparable with control. General linear modelling showed

a different course of glycaemia (p = 0.041) in the ankylosing

spondylitis patients who met the criteria for a successful IIH test

compared with the controls.

CONCLUSIONS: The results suggest there is no difference in basal HPA

axis activity and completely preserved responsiveness of the HPA axis in

patients with ankylosing spondylitis. The interpretation of the

different course of glycaemia during IIH in ankylosing spondylitis

requires further investigation.

PMID: 15140773

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