Chronic Infectious Enteritis and Dysregulation of the Hypothalamic Pituitary Adrenal Axis

Abstract

Purpose: Perturbations of the hypothalamic-pituitary-adrenal axis (HPA) are known to occur in the setting of chronic disease. Cortisol affects many of the body's vital functions. DHEA-S plays an essential role in cortisol dynamics. Concurrent analysis of salivary cortisol and DHEA-S provides an accurate measure of adrenal function. Twenty-four hour circadian panels of salivary cortisol and DHEA-S were obtained in patients with chronic infectious enteritis to investigate adrenal function. Methods: Patients with a diagnosis of chronic infectious enteritis (CIE) who had salivary analysis of cortisol (8AM, 12PM, 4PM, 8PM, 12AM, and 4AM) and DHEA-S (8AM, 8PM, and 12AM) (Sabre Sciences, Inc., Carlsbad, CA) were retrospectively analyzed for circadian adrenal profile compared to normal controls. Results: Overall, 87 patients were analyzed of which there were 37 females and 50 males. The mean age was 44 years. Cortisol levels (Table and Figure 1) showed the average 4AM levels as elevated. DHEA-S levels (Table and Figure 2) showed averages within normal range and an inversion demonstrating an abnormality in the normal circadian rhythm of the HPA.Table 1: Cortisol averages (ng/ml)Table 2: DHEA-S averages (ng/ml)Figure 1Figure 1Conclusion: Patients with CIE develop HPA dysregulation on the basis of salivary cortisol and DHEA-S levels and patterns. This extra intestinal disorder in patients with CIE has broad clinical significance and implications for therapy. Patients with CIE should be examined for adrenal dysfunction with salivary cortisol and DHEA-S measurement as a simple, non-invasive screening test. Patients with this pattern of HPA should be examined for CIE. Disclosure: Dr Borkin-Employee Sabre Sciences, Inc.