INTACT ADRENOCORTICOTROPIC HORMONE-SECRETION BUT IMPAIRED CORTISOL RESPONSE IN PATIENTS WITH ACTIVE RHEUMATOID-ARTHRITIS - EFFECT OF GLUCOCORTICOIDS

Objective. To study the hypothalamic-pituitary-adrenal axis in rheumat oid arthritis (RA) and the; influence of glucocorticoid treatment. Met hods. Consecutive untreated patients with RA with moderately high infl ammatory activity were studied and compared with healthy subjects of s imilar age, Subjects were studied both at baseline and after multiple releasing hormone (MRH) stimulation, Patients were reexamined one week after starting prednisolone.Results. The baseline cortisol/adrenocort icotropic hormone (ACTH) ratio was significantly lower in patients wit h RA. After corticotropin releasing hormone (CRH) stimulation, their s erum cortisol response was reduced during the later test phases in spi te of intact ACTH response. The baseline and stimulated levels of lute inizing hormone (LH), follicle stimulating hormone (FSH), and thyroid stimulating hormone (TSH) were normal. An impaired prolactin response was seen after MRH stimulation, After one week of prednisolone therapy the absolute response of serum cortisol to CRH was decreased and the stimulated prolactin response was normalized. Conclusion. Impaired cor tisol secretion in patients with RA in the presence of intact ACTH sec retion is consistent with relative adrenal glucocorticoid insufficienc y, Adrenal impairment may be secondary to the inflammatory disease pro cess.