Studies on adrenal cortical activity in patients with rheumatoid arthritis: The diurnal pattern and twenty-four hour levels of urinary total 17-hydroxycorticosteroids and 17-ketosteroids

Abstract

A h . These studies were supported by funds from the National I d t u t e of Arthritis and Metabolic Diseases, National Institutes of Health, U.S.P.H.S., and the A. H . Robins Company, Inc. Three of the authors (A. V., L. L. H. and J. H . McN.) are Trainees of the X&nal Institute of Arthritis and Metabolic Diseases, National Institutes of Health, U.S.P.H.S. 114ADRENAL CORTICAL ACXIVITY M RHEUMATOID ARTHRITIS 115 els have been found by several investigators,l2*21-23 while another reported low pIasma corticoid concentrations.2* Still another study demonstrated values in the upper limits of normal using the blue tetrazolium and phenylhydrazine reactions. These were associated with high absolute and relative values for "F-like" substances in plasma.2s These and other performed on patients with rheumatoid arthritis suggest that while gross adrenal cortical secretory activity is apparently within normal limits, subtle, yet signScant, deviations from normal may occur.Many of the foregoing studies have utilized changes in urinary 17-ketosteroid or unconjugated ll-oxy-or 17-hydroxycorticosteroid levels as indicators of adrenal cortical activity. It is now well appreciated that these indexes are either not entirely s p e d c (urinary excretion of 17-ketosteroids in males) or only partial (unconjugated corticosteroid levels) indicators of adrenal cortical activity. The availability of more precise technics for meas-

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

“…Subsequent attempts during the 1950s and early 1960s to critically analyze adrenal cortical relationships to the etiology of RA were inconclusive (5,6). In that era, time-and laborintensive methods were needed to assay the various urinary steroid metabolites and serum levels of the relevant hormones.…”

Neuroendocrine-immune system in patients with rheumatoid arthritis

“…5,6 RA patients tend to be exposed to long-term physical and psychological stress during the course of their disease, and their neuroendocrine-immune system will become dysregulated, as has been reported elsewhere. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The stress-response system consists of neural (psychological), endocrine, and immune components which interact with each other. Thus, humoral and cellular factors related to these components will be changed by psychological or physical stress.…”

Corticosteroids in Rheumatoid Arthritis

“…Previous studies 1 have shown that while the daily urinary excretion of 17-ketosteroids in patients with rheumatoid arthritis did not differ from that seen in normal subjects, the excretion of urinary 17-hydroxycorticosteroids was slightly diminished from the mean level observed in normal subjects, due to a lower output during the early morning hours. Although these mean urinary steroid values in patients with rheumatoid arthritis differed slightly from those found in normal subjects, they were not significantly different from those seen in patients with nonrheumatic chronic illnesses.…”