RT Journal Article
SR Electronic
T1 Infusion of epinephrine decreases serum levels of cortisol and 17-hydroxyprogesterone in patients with rheumatoid arthritis.
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1659
OP 1664
VO 29
IS 8
A1 Rainer H Straub
A1 Jens M Kittner
A1 Cobi Heijnen
A1 Manfred Schedlowski
A1 Reinhold E Schmidt
A1 Roland Jacobs
YR 2002
UL http://www.jrheum.org/content/29/8/1659.abstract
AB OBJECTIVE: To investigate the pituitary and adrenal hormone response after an intravenous epinephrine challenge in patients with rheumatoid arthritis (RA) and controls. METHODS: Fifteen untreated female patients with RA (age 51.5 +/- 3.2 yrs) and 7 healthy female controls (48.0 +/- 4.3 yrs) were infused with epinephrine (0.05 microg/kg/min) for about 20 min. Plasma levels of adrenocorticotropic hormone (ACTH), and serum levels of cortisol, 17-hydroxyprogesterone (17OHP), and dehydroepiandrosterone sulfate (DHEAS) were analyzed at baseline and shortly after cessation of epinephrine infusion (20 min). RESULTS: At baseline and after epinephrine infusion, serum levels of cortisol (p = 0.045) and 17OHP (p = 0.021) were higher in controls compared to patients with RA. In contrast, at baseline and after epinephrine infusion, plasma levels of ACTH and serum levels of DHEAS were similar in controls and patients. After epinephrine infusion, only the patients with RA had a significant decrease of serum cortisol (p = 0.026) and serum 17OHP (p = 0.026). Plasma levels of ACTH (p = 0.073) and serum levels of DHEAS (p = 0.055) tended to decrease. CONCLUSION: Serum cortisol and 17OHP (cortisol precursor) were lower in patients with RA compared to controls despite similar ACTH levels. Simulation of an adrenomedullary stress response by epinephrine infusion decreased serum cortisol and 17OHP in patients but not in controls. Such a response may play an unfavorable role during a typical stress reaction in patients with RA that may lead to a more proinflammatory situation.