Hypothalamic-Pituitary-Adrenal Axis Responses in Women with Endometriosis-Related Chronic Pelvic Pain.
Hypothalamic-Pituitary-Adrenal Axis Responses in Women with Endometriosis-Related Chronic Pelvic Pain.
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子宫内膜异位症相关慢性盆腔疼痛女性的下丘脑-垂体-肾上腺轴反应。
DOI：
10.1007/s43032-020-00201-x
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Stratton,Pamela
中科院分区：
文献类型：
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作者：
Ortiz,Robin;Gemmill,JulieAnneL;Sinaii,Ninet;Stegmann,Barbara;Khachikyan,Izabella;Chrousos,George;Segars,James;Stratton,Pamela
一些慢性疼痛疾病和合并症抑制下丘脑-垂体-肾上腺（HPA）轴和对动态测试的反应。我们测量了HPA轴对促肾上腺皮质激素释放激素（CRH）给药的反应与慢性盆腔疼痛和子宫内膜异位症的关系。在一项横断面研究中，54名女性（n = 22）患有退行性变相关的慢性盆腔疼痛，12名仅患有慢性盆腔疼痛，20名健康志愿者在静脉注射绵羊CRH后0、15、30和45 min测量促肾上腺皮质激素释放激素（ACTH）和皮质醇水平。按研究组比较ACTH和皮质醇δ（峰值-基线）和曲线下面积（AUC），并评估其与种族、月经和非月经疼痛严重程度的相关性。HPA轴的反应在不同种族的人群中没有差异，疼痛的人群与健康志愿者相比也没有差异。然而，当按种族分层时，（129.9 ± 130.7 vs. 52.5 ± 66.0 pg/mL; p = 0.003），ACTH AUC（4813 ± 4707 vs. 2290 ± 2900 min * pg/mL; p = 0.013），皮质醇δ（26.3 ± 21.5 vs. 13.2 ± 9.7 μ g/mL; p = 0.005）在黑人（n = 10）中显著高于以白色（非黑人）为主的受试者（n = 44; 39/44白色）。在主要是白色（非黑人）女性的分析中，更严重的月经疼痛与ACTH δ（p = 0.015）和皮质醇δ（p = 0.023）的钝化有关，更严重的非月经疼痛与皮质醇δ（p = 0.017）的钝化有关。慢性盆腔痛妇女的神经内分泌异常可能因疼痛表现而异，也可能因种族而异。黑人女性的HPA轴反应更高，值得在按种族分层的盆腔疼痛研究中进行调查。在经历疼痛的白色（非黑人）女性中，迟钝的反应与疼痛的严重程度相关，表明疼痛独立于子宫内膜异位症病变影响女性。
Some chronic pain conditions and comorbidities suppress the hypothalamic-pituitary-adrenal (HPA) axis and response to dynamic testing. We measured HPA axis responses to corticotropin-releasing hormone (CRH) administration in relation to chronic pelvic pain and endometriosis. In a cross-sectional study of women (n= 54) with endometriosis-associated chronic pelvic pain (n= 22), chronic pelvic pain alone (n= 12), or healthy volunteers (n= 20), adrenocorticotropic-releasing hormone (ACTH) and cortisol levels were measured at 0, 15, 30, and 45 min after intravenous ovine CRH administration. ACTH and cortisol delta (peak-baseline) and area under the curve (AUC) were compared by study group and assessed for association with race and menstrual and non-menstrual pain severity. HPA axis responses did not differ among the racially diverse groups or in those with pain compared with healthy volunteers. However, when stratified by race, ACTH delta (129.9 ± 130.7 vs. 52.5 ± 66.0 pg/mL;p= 0.003), ACTH AUC (4813 ± 4707 vs. 2290 ± 2900 min*pg/mL;p= 0.013), and cortisol delta (26.3 ± 21.5 vs. 13.2 ± 9.7 μg/mL;p= 0.005) were significantly higher in black (n= 10) than predominately white (non-black) subjects (n= 44; 39/44 white). In analyses among primarily white (non-black) women, greater menstrual pain severity was associated with blunted ACTH delta (p= 0.015) and cortisol delta (p= 0.023), and greater non-menstrual pain severity with blunted cortisol delta (p= 0.017). Neuroendocrine abnormalities in women with chronic pelvic pain may differ by pain manifestations and may vary by race. The higher HPA axis response in black women merits investigation in pelvic pain studies stratified by race. In white (non-black) women experiencing pain, a blunted response was related to pain severity suggesting pain affects women independently of endometriosis lesions.