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Adrenal Size Is Increased in Multiple Sclerosis

Adrenal Size Is Increased in Multiple Sclerosis Abstract Objective: To determine if adrenal glands are enlarged in multiple sclerosis (MS). Patients with MS and major depression are insensitive to glucocorticoid feedback regulation. Depressed patients have excessively high glucocorticoid levels and enlarged adrenal glands. To our knowledge, this is the first study of adrenal size in MS. Chronic high levels of adrenal glucocorticoid in MS may downregulate responses to exogenous or endogenous steroids. Design: Retrospective postmortem analysis compared adrenal size in MS with that in other neurologic and non-neurologic diseases. Setting: Autopsy cases were obtained from the records of a tertiary care hospital. Patients: Ten patients had definite MS; 13, amyotrophic lateral sclerosis; and 14, acute myocardial infarction. Main Outcome Measures: Adrenal and body weight at autopsy. Results: At postmortem examination, the adrenal glands of patients with MS were enlarged in comparison with the adrenal glands of patients who died of acute myocardial infarction or amyotrophic lateral sclerosis. The adrenal glands of the patients with MS were 36% larger than those of the patients with amyotrophic lateral sclerosis who had comparable body weights. The adrenal-body weight ratio was 40% greater in patients with MS than in patients who died of acute myocardial infarction. Conclusions: The increased adrenal size in patients with MS may allow excessive glucocorticoid secretion in response to stress and affect immune regulation. References 1. Blalock JE. A molecular basis for bidirectional communication between the immune and neuroendocrine systems . Physiol Rev . 1989;69:1-32. 2. Selye H. A syndrome produced by diverse nocuous agents . Nature . 1936;138:32.Crossref 3. Mason D, MacPhee I, Antoni F. The role of the neuroendocrine system in determining genetic susceptibility to experimental allergic encephalomyelitis in the rat . Immunology . 1990;70:1-5. 4. Rosenthale ME, Datko LJ, Kassarich J, Schneider F. Chemotherapy of experimental allergic encephalomyelitis (EAE) . Arch Int Pharmacodyn . 1969;179:251-275. 5. Bolton C, Flower RJ. The effects of the anti-glucocorticoid RU 38486 on steroid-mediated suppression of experimental allergic encephalomyelitis (EAE) in the Lewis rat . Life Sci . 1989;45:97-104.Crossref 6. Sternberg EM, Young WS, Bernardini R, et al. A central nervous system defect in biosynthesis of corticotropin-releasing hormone is associated with susceptibility to streptococcal cell wall-induced arthritis in Lewis rats . Proc Natl Acad Sci U S A . 1989;86:4771-4775.Crossref 7. Reder AT, Lowy MT, Meltzer HY, Antel JP. Dexamethasone suppression test abnormalities in multiple sclerosis: relation to ACTH therapy . Neurology . 1987;37:849-853.Crossref 8. Lowy MT, Reder AT, Antel JP, Meltzer HY. Glucocorticoid resistance in depression: relationship between the DST and lymphocyte sensitivity to dexamethasone . Arch Gen Psychiatry . 1984;141:1365-1370. 9. Amsterdam JD, Marinelli DL, Arger P, Winokur A. Assessment of adrenal gland volume by computed tomography in depressed patients and healthy volunteers: a pilot study . Psychiatry Res . 1987;21:189-197.Crossref 10. Nemeroff CB, Dunnick NR, Boyko O, et al. Pituitary and adrenal alterations in major depression: MRI . J Neurol Sci . 1990;16:139. Abstract 59.4. 11. Nemeroff CB, Krishnan KRR, Reed D, Leder R, Beam C, Dunnick R. Adrenal gland enlargement in major depression . Arch Gen Psychiatry . 1992;49:384-387.Crossref 12. Dorovini-Zis K, Zis AP. Increased adrenal weight in victims of violent suicide . Am J Psychiatry . 1987;144:1214-1215. 13. Krishnan RR, Doraiswamy PM, Lurie SN, et al. Pituitary size in depression . J Clin Endocrinol Metab . 1991;72:256-259.Crossref 14. Allen J, Powers C, Kepic Talareco J, Garwacki D, Swank R. Plasma peptide concentrations in patients with multiple sclerosis (MS) . Clin Res . 1980;28:255A. Abstract. 15. Rose AS, Kuzma JW, Kurtzke JF, et al. Cooperative study in the evaluation of therapy in multiple sclerosis: ACTH vs. placebo—final report . Neurology . 1970; 20( (pt 2) ):1-59. 16. Van Eekelen JAM, Rots NY, Sutanto W, Kloet ER. The effect of aging on stress responsiveness and central corticosteroid receptors in the Brown Norway rat . Neurobiol Aging . 1991;13:159-170.Crossref 17. Akana SF, Shinsako J, Dallman MF. Relationships among adrenal weight, corticosterone, and stimulated adrenocorticotropin levels in rats . Endocrinology . 1983;113:2226-2231.Crossref 18. Malendowicz K. A correlated stereological and functional studies [sic] on the long-term effects of ACTH on rat adrenal cortex . Folia Histochem Cytobiol . 1986;24: 203-211. 19. Maida E, Summer K. Serum cortisol levels of multiple sclerosis patients during ACTH treatment . J Neurol . 1979;220:143-148.Crossref 20. Jaeckle RS, Kathol RG, Lopez JF, Meller WH, Krummel SJ. Enhanced adrenal sensitivity to exogenous cosyntropin (ACTH α1-24) stimulation in major depression . Arch Gen Psychiatry . 1987;44:233-240.Crossref 21. Studzinski GP, Hay DCF, Symington T. Observations on the weight of the human adrenal gland and the effect of preparations of corticotropin of different purity on the weight and morphology of the human adrenal gland . J Clin Endocrinol Metab . 1963;23:248-254.Crossref 22. Spencer RL, McEwen BS. Adaptation of the hypothalamic-pituitary-adrenal axis to chronic ethanol stress . Neuroendocrinology . 1990;52:481-489.Crossref 23. Reder AT. ACTH production by mononuclear cells . Immunology . 1992;77:436-442. 24. Reder AT, Arnason BGW. Immunology of multiple sclerosis . In: Vinken PJ, Bruyn GW, Klawans HL, Koetsier JC, eds. Handbook of Clinical Neurology: Demyelinating Diseases . Amsterdam, the Netherlands: Elsevier Science Publishers; 1985:3:337-395. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Adrenal Size Is Increased in Multiple Sclerosis

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1994.00540140057015
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine if adrenal glands are enlarged in multiple sclerosis (MS). Patients with MS and major depression are insensitive to glucocorticoid feedback regulation. Depressed patients have excessively high glucocorticoid levels and enlarged adrenal glands. To our knowledge, this is the first study of adrenal size in MS. Chronic high levels of adrenal glucocorticoid in MS may downregulate responses to exogenous or endogenous steroids. Design: Retrospective postmortem analysis compared adrenal size in MS with that in other neurologic and non-neurologic diseases. Setting: Autopsy cases were obtained from the records of a tertiary care hospital. Patients: Ten patients had definite MS; 13, amyotrophic lateral sclerosis; and 14, acute myocardial infarction. Main Outcome Measures: Adrenal and body weight at autopsy. Results: At postmortem examination, the adrenal glands of patients with MS were enlarged in comparison with the adrenal glands of patients who died of acute myocardial infarction or amyotrophic lateral sclerosis. The adrenal glands of the patients with MS were 36% larger than those of the patients with amyotrophic lateral sclerosis who had comparable body weights. The adrenal-body weight ratio was 40% greater in patients with MS than in patients who died of acute myocardial infarction. Conclusions: The increased adrenal size in patients with MS may allow excessive glucocorticoid secretion in response to stress and affect immune regulation. References 1. Blalock JE. A molecular basis for bidirectional communication between the immune and neuroendocrine systems . Physiol Rev . 1989;69:1-32. 2. Selye H. A syndrome produced by diverse nocuous agents . Nature . 1936;138:32.Crossref 3. Mason D, MacPhee I, Antoni F. The role of the neuroendocrine system in determining genetic susceptibility to experimental allergic encephalomyelitis in the rat . Immunology . 1990;70:1-5. 4. Rosenthale ME, Datko LJ, Kassarich J, Schneider F. Chemotherapy of experimental allergic encephalomyelitis (EAE) . Arch Int Pharmacodyn . 1969;179:251-275. 5. Bolton C, Flower RJ. The effects of the anti-glucocorticoid RU 38486 on steroid-mediated suppression of experimental allergic encephalomyelitis (EAE) in the Lewis rat . Life Sci . 1989;45:97-104.Crossref 6. Sternberg EM, Young WS, Bernardini R, et al. A central nervous system defect in biosynthesis of corticotropin-releasing hormone is associated with susceptibility to streptococcal cell wall-induced arthritis in Lewis rats . Proc Natl Acad Sci U S A . 1989;86:4771-4775.Crossref 7. Reder AT, Lowy MT, Meltzer HY, Antel JP. Dexamethasone suppression test abnormalities in multiple sclerosis: relation to ACTH therapy . Neurology . 1987;37:849-853.Crossref 8. Lowy MT, Reder AT, Antel JP, Meltzer HY. Glucocorticoid resistance in depression: relationship between the DST and lymphocyte sensitivity to dexamethasone . Arch Gen Psychiatry . 1984;141:1365-1370. 9. Amsterdam JD, Marinelli DL, Arger P, Winokur A. Assessment of adrenal gland volume by computed tomography in depressed patients and healthy volunteers: a pilot study . Psychiatry Res . 1987;21:189-197.Crossref 10. Nemeroff CB, Dunnick NR, Boyko O, et al. Pituitary and adrenal alterations in major depression: MRI . J Neurol Sci . 1990;16:139. Abstract 59.4. 11. Nemeroff CB, Krishnan KRR, Reed D, Leder R, Beam C, Dunnick R. Adrenal gland enlargement in major depression . Arch Gen Psychiatry . 1992;49:384-387.Crossref 12. Dorovini-Zis K, Zis AP. Increased adrenal weight in victims of violent suicide . Am J Psychiatry . 1987;144:1214-1215. 13. Krishnan RR, Doraiswamy PM, Lurie SN, et al. Pituitary size in depression . J Clin Endocrinol Metab . 1991;72:256-259.Crossref 14. Allen J, Powers C, Kepic Talareco J, Garwacki D, Swank R. Plasma peptide concentrations in patients with multiple sclerosis (MS) . Clin Res . 1980;28:255A. Abstract. 15. Rose AS, Kuzma JW, Kurtzke JF, et al. Cooperative study in the evaluation of therapy in multiple sclerosis: ACTH vs. placebo—final report . Neurology . 1970; 20( (pt 2) ):1-59. 16. Van Eekelen JAM, Rots NY, Sutanto W, Kloet ER. The effect of aging on stress responsiveness and central corticosteroid receptors in the Brown Norway rat . Neurobiol Aging . 1991;13:159-170.Crossref 17. Akana SF, Shinsako J, Dallman MF. Relationships among adrenal weight, corticosterone, and stimulated adrenocorticotropin levels in rats . Endocrinology . 1983;113:2226-2231.Crossref 18. Malendowicz K. A correlated stereological and functional studies [sic] on the long-term effects of ACTH on rat adrenal cortex . Folia Histochem Cytobiol . 1986;24: 203-211. 19. Maida E, Summer K. Serum cortisol levels of multiple sclerosis patients during ACTH treatment . J Neurol . 1979;220:143-148.Crossref 20. Jaeckle RS, Kathol RG, Lopez JF, Meller WH, Krummel SJ. Enhanced adrenal sensitivity to exogenous cosyntropin (ACTH α1-24) stimulation in major depression . Arch Gen Psychiatry . 1987;44:233-240.Crossref 21. Studzinski GP, Hay DCF, Symington T. Observations on the weight of the human adrenal gland and the effect of preparations of corticotropin of different purity on the weight and morphology of the human adrenal gland . J Clin Endocrinol Metab . 1963;23:248-254.Crossref 22. Spencer RL, McEwen BS. Adaptation of the hypothalamic-pituitary-adrenal axis to chronic ethanol stress . Neuroendocrinology . 1990;52:481-489.Crossref 23. Reder AT. ACTH production by mononuclear cells . Immunology . 1992;77:436-442. 24. Reder AT, Arnason BGW. Immunology of multiple sclerosis . In: Vinken PJ, Bruyn GW, Klawans HL, Koetsier JC, eds. Handbook of Clinical Neurology: Demyelinating Diseases . Amsterdam, the Netherlands: Elsevier Science Publishers; 1985:3:337-395.

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 1994

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