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Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

R Imrich¹, J Rovensky², M Zlnay², Z Radikova¹, L Macho¹, M Vigas¹, J Koska¹

¹ Institute of Experimental Endocrinology SAS, Bratislava, Slovakia
² National Institute of Rheumatic Diseases, Piestany, Slovakia

Correspondence to:
Correspondence to:
Dr Richard Imrich
Institute of Experimental Endocrinology, Slovak Academy of Sciences, Vlarska 3, 833 06 Bratislava, Slovakia; richard.imrich{at}savba.sk

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), 17-hydroxyprogesterone, interleukin 6 (IL-6), and tumour necrosis factor (TNF) 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 TNF (8.5 (1.74) pg/ml v 4.08 (0.42) pg/ml in controls; p<0.01). Glucose, insulin, ACTH, DHEAS, and 17-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.

Keywords: cortisol; hypothalamic-pituitary-adrenal axis; insulin resistance; ankylosing spondylitis

Abbreviations: DHEAS, dehydroepiandrosterone sulphate; HPA, hypothalamic-pituitary-adrenal; IIH, insulin induced hypoglycaemia; 17-OHP, 17-hydroxyprogesterone

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