RESEARCH - Diurnal secretion of growth hormone, cortisol, and DHEA in pre- and perimenopausal women with active RA

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Arthritis Research & Therapy

Research article

28 Jul 2007

Diurnal secretion of growth hormone, cortisol, and

dehydroepiandrosterone in pre- and perimenopausal women with active

rheumatoid arthritis: a pilot case-control study

Marc R Blackman1 , Ranganath Muniyappa1 , Mildred 2 , Barbara E

Moquin1 , L Baldwin1 , Kelli A Wong1 , Snyder2 ,

Magalnick2 , Shaan Alli2 , Reynolds3 , Seth M Steinberg4

and Raphaela Goldbach-Mansky2

1Endocrine Section, Laboratory of Clinical Investigation, National

Center for Complementary and Alternative Medicine, National Institutes

of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA

2Office of the Clinical Director, National Institute of Arthritis and

Musculoskeletal and Skin Diseases, National Institutes of Health, 9000

Rockville Pike, Bethesda, MD 20892, USA

3Department of Radiology, Warren Magnuson Clinical Center, National

Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA

4Biostatistics and Data Management Section, Center for Cancer

Research, National Cancer Institute, National Institutes of Health,

9000 Rockville Pike, Bethesda, MD 20892, USA

Abstract

Rheumatoid arthritis (RA) is associated with neuroendocrine and

immunologic dysfunction leading to rheumatoid cachexia. Although

excess proinflammatory cytokines can decrease somatotropic axis

activity, little is known about the effects of RA on growth

hormone/insulin-like growth factor-1 (GH/IGF-I) axis function. We

tested the hypothesis that patients with active RA exhibit decreased

GH/IGF-I axis activity. To do so, we conducted a pilot case-control

study at a clinical research center in 7 pre- and perimenopausal women

with active RA and 10 age- and body mass index-matched healthy women.

Participants underwent blood sampling every 20 minutes for 24 hours (8

a.m. to 8 a.m.), and sera were assayed for GH, cortisol, and

dehydroepiandrosterone (DHEA). Sera obtained after overnight fasting

were assayed for IGF-I, IGF-binding protein (IGFBP)-1, IGFBP-3,

C-reactive protein (CRP), interleukin-6 (IL-6), glucose, insulin, and

lipids. Body composition and bone mineral density were evaluated by

DEXA (dual emission x-ray absorptiometry) scans. In patients with RA,

mean disease duration was 7.6 ± 6.8 years, and erythrocyte

sedimentation rate, CRP, and IL-6 were elevated. GH half-life was

shorter than in control subjects (p = 0.0037), with no other

significant group differences in GH deconvolution parameters or

approximate entropy scores. IGF-I (p = 0.05) and IGFBP-3 (p = 0.058)

were lower, whereas IGFBP-1 tended to be higher (p = 0.066), in

patients with RA, with nonsignificantly increased 24-hour total GH

production rates. There were no significant group differences in

cortisol or DHEA secretion. Lean body mass was lower in patients with

RA (p = 0.019), particularly in the legs (p = 0.01). Women with active

RA exhibit a trend toward GH insensitivity and relatively diminished

diurnal cortisol and DHEA secretion for their state of inflammation.

Whether these changes contribute to rheumatoid cachexia remains to be

determined.

Trial registration number

NCT00034060.

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Read the entire article here:

http://arthritis-research.com/content/9/4/R73

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