Changes of opioid modulation of the hypothalamo-pituitary-adrenal axis in patients with severe premenstrual syndrome.

Abstract

To assess the function of the hypothalamus-pituitary-adrenal axis in patients with severe premenstrual syndrome (PMS) 28 patients and 14 asymptomatic controls were studied during the mid-to late-luteal phase of the menstrual cycle. The response of plasma cortisol to both high-dose naloxone and corticotropinreleasing hormone (CRH) was assessed. Naloxone stimulated a significant cortisol release in controls whereas it was otherwise almost absent in patients. CRH stimulated a greater release of cortisol in patients than in controls. Fifteen patients met criteria for either current anxiety and/or mood disorders. The cortisol secretion after both naloxone and CRH stimulations was similar for PMS patients with or without psychiatric disorders. These data indicate that endogenous opioids modulate the activity of the hypothalamus-pituitary-adrenal axis. Irrespective of the concomitant presence of menstrual migraine or psychiatric disorder, such control is altered in patients with severe PMS because of the possible hyposensitivity of opiate receptors. The hyperresponsiveness to CRH may be the consequence of the reduced inhibition that endogenous opioids tonically exert on HPA axis.

Naloxone does not influence cardiovascular responses to mild mental stress in postmenopausal women

“…On the other hand, this study demonstrated in both groups a significant increase in serum cortisol concentrations in response to naloxone. This result confirms for postmenopausal women the inhibitory effect of the endogenous opioid system on the HPA axis observed in other studies for younger women and men (10,15,25). As these responses were unrelated to HRT use, the opioidergic regulation of the HPA axis seems, in contrast to the HPG axis, not to be dependent on sex steroids.…”

Family History of Alcoholism and Hypothalamic Opioidergic Activity

“…As a result of opioidergic modulation of CRF neurons, this test can identify alterations in endogenous opioid activity. [34][35][36][37][38][39] For example, persons with less opioid activity (less inhibitory tone directed at the CRF neuron) would be maximally blocked (plateau in cortisol levels) by a lower dose of naloxone compared with individuals with greater opioid activity (more inhibitory tone) who require higher doses of naloxone to induce blockade. Thus, opioid receptor blockade by naloxone provides a functional assessment of opioid activity.…”

Gonadal Hormones, Women and Pain

“…Facchinetti et al [27] reported a blunted increase of serum concentrations of cortisol and -endorphin during the premenstrual phase after intravenous administration of naloxone in women with menstrual migraine. The response was normal during the follicular phase, suggesting that there was a cyclic failure of opiate tonus in patients with menstrual migraine.…”