Adrenal androgen and glucocorticoid dissociation in premenopausal rheumatoid arthritis: a significant correlate or precursor to onset?

Controlled studies of adrenal steroids in premenopausal women with rheumato id arthritis (RA) have revealed subtle and inconsistent decreases in glucoc orticosteroid (GCS) function, but prominent deficiencies of adrenal androge ns (AA), Such findings have suggested that hypoandrogenicity may predispose to RA in younger women. However, recent prospective studies of serum corti sol and dehydroepiandrosterone sulfate (DHEAS) levels before ((x) over bar = 12 yrs) the onset of the disease (pre-RA) offer an alternative perspectiv e. Significant dissociation of serum cortisol and DHEAS levels was found on ly ill the subgroup of premenopausal women who developed RA before age 50. This subgroup alone had significant deficiency in serum DHEAS levels. Aggre gate data imply that the documented deficits of DHEAS (and other AA) in suc h young females are a correlate of relative adrenal insufficiency, and that subtle GCS dysfunction may either contribute to development of RA in such young women as well as pubertal girls or may predispose to earlier onset of disease.