Data from: Cortisol awakening response is linked to disease course and progression in multiple sclerosis

OBJECTIVES: Dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis
has frequently been reported in multiple sclerosis (MS). So far, HPA axis
function in MS has predominantly been studied under pharmacological
stimulation which is associated with a series of methodological caveats.
Knowledge of circadian cortisol patterns and cortisol awakening response
(CAR) is still limited. METHODS: A total of 77 MS patients (55
relapsing-remitting MS (RRMS) / 22 secondary-progressive MS (SPMS)) as
well as 34 healthy control (HC) subjects were enrolled. Diurnal cortisol
release was assessed by repeated salivary cortisol sampling. Neurological
disability was rated by the Kurtzke’s Expanded Disability Status Scale
(EDSS). Depressive symptoms and perceived stress were assessed by
self-report measures. RESULTS: RRMS but not SPMS patients differed in
circadian cortisol release from HC subjects. Differences in cortisol
release were restricted to CAR. Treated and treatment naïve RRMS patients
did not differ in CAR. In a RRMS follow-up cohort (nine months follow-up),
RRMS patients with EDSS progression (≥ 0.5) expressed a significantly
greater CAR compared to HC subjects. RRMS patients with a stable EDSS did
not differ from HC subjects. Neither depressive symptoms nor perceived
stress ratings were associated with CAR in RRMS patients. In a step-wise
regression analysis, EDSS at baseline and CAR were predictive of EDSS at
follow-up (R² = 67 %) for RRMS patients. CONCLUSIONS: Circadian cortisol
release, in particular CAR, shows a course specific pattern with most
pronounced release in RRMS. There is also some evidence for greater CAR in
RRMS patients with EDSS progression. As a consequence, CAR might be of
predictive value in terms of neurological disability in RRMS patients. The
possible role of neuroendocrine-immune interactions in MS pathogenesis is
further discussed.