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Hypothalamic–pituitary–adrenal axis function in traumatic spinal cord injury-related neuropathic pain: a case–control study

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Abstract

Purpose

This study aimed to investigate the hypothalamic–pituitary–adrenal (HPA) axis in spinal cord injury (SCI)-related neuropathic pain (NP) using dynamic adrenocorticotropic hormone (ACTH) stimulation tests.

Methods

This case–control study was conducted with 22 patients diagnosed with traumatic chronic spinal cord injury (15 with and 7 without neuropathic pain) and ten age- and sex-matched healthy control subjects. Collected data included socio-demographic variables, SCI characteristics, and level of NP using a numeric rating scale (NRS) and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS). HPA axis function was measured via low-dose (1 μg) and standard-dose (250 μg) ACTH tests (LDT and SDT, respectively).

Results

No significant differences existed regarding peak cortisol responses or area under the curve (AUC) of cortisol responses between the SCI patients with NP and healthy controls using LDT and SDT. In the SCI patients without pain, cortisol responses were significantly lower than those in the healthy controls for LDT and SDT. Peak cortisol and AUC responses of the LDT and SDT were positively correlated with NRS in SCI patients with NP.

Conclusions

This study demonstrated that, in chronic SCI patients with NP, basal cortisol levels are relatively higher compared to healthy controls, and that HPA axis can be activated with low- and standard-dose ACTH stimulation tests. Although NP following SCI was not significantly associated with hypo- or hypercortisolemia, either after low- or standard-dose ACTH stimulation test, the severity of NP during chronic SCI may be positively associated with HPA axis activity.

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Acknowledgements

This study was supported by a grant from the Research Fund of the Erciyes University (Project Number TTU-2015-5672). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Erciyes University, Faculty of Medicine.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Adiyaman University Training and Research Hospital, Yunus Emre Mah. 1164 Sk. No: 13, 02000, Merkez, Adiyaman, Turkey

    E. Cuce & I. Cuce

  2. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    H. Demir

  3. Department of Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    F. Bayram

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  1. E. Cuce
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Correspondence to I. Cuce.

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Cuce, E., Demir, H., Cuce, I. et al. Hypothalamic–pituitary–adrenal axis function in traumatic spinal cord injury-related neuropathic pain: a case–control study. J Endocrinol Invest 42, 923–930 (2019). https://doi.org/10.1007/s40618-019-1002-9

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  • DOI: https://doi.org/10.1007/s40618-019-1002-9

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