Low serum dehydroepiandrosterone sulfate in women with primary Sjogren's syndrome as an isolated sign of impaired HPA axis function

Objective. To assess the hypothalamic-pituitary-adrenal (HPA) and thyroid a xes in women with primary Sjogren's syndrome (pSS). Methods, In 10 women with pSS and 10 age matched female controls, we evalua ted serum dehydroepiandrosterone sulfate (DHEA-S), testosterone, androstene dione, follicle stimulating hormone, luteinizing hormone, thyroid stimulati ng hormone, prolactin, growth hormone, sex hormone binding globulin, cortis ol, and adrenocorticotropin hormone (ACTH), in both basal condition and aft er stimulation with corticotropin releasing hormone, thyrotropin releasing hormone, and luteinizing hormone releasing hormone intravenously. Patients had not previously been treated with glucocorticoids. Results. Patients with pSS had significantly lower basal mean DHEA-S values compared with healthy controls (2.4 +/- 0.4 vs 3.9 +/- 0.3 mu mol/l; p < 0 .05) and significantly lower DHEA-S values after stimulation. The cortisol/ DHEA-S ratio in the patient group was higher than in controls (171 +/- 39 v s 76 +/- 5; p < 0.05). A correlation was found between basal ACTH and DHEA- S values in the patients (r = 0.650; p = 0.05). No correlation was seen bet ween disease activity or age and the serum concentration of DHEA-S. The lev els of other hormones both at baseline and after stimulation were similar i n patients and controls. Conclusion. The results show that women with pSS have intact cortisol synth esis but decreased serum concentrations of DHEA-S and increased cortisol/DH EA-S ratio compared with healthy controls. The findings may reflect a const itutional or disease mediated influence on adrenal steroid synthesis. The t hyroid axis and gonadotropin secretion were similar in patients and control s.