Studies on Hormones

[LymeEnigma]

European Journal of Endocrinology, Vol 158, Issue 1, 3-9
Copyright © 2008 by Society of the European Journal of Endocrinology

Hypothalamic–pituitary insufficiency following infectious diseases of the central nervous system

S Schaefer, N Boegershausen, S Meyer, D Ivan, K Schepelmann1 and P H Kann

Division of Endocrinology and Diabetology, Philipps University Hospital, Baldingerstrasse, D-35033 Marburg, Germany and 1 Department of Neurology, Philipps University Hospital, Marburg, Germany

(Correspondence should be addressed to S Schaefer; Email: [e-mail])

Abstract

Objective: Hypothalamic–pituitary insufficiency may have diverse causes. The aim of this study was to determine the incidence of hypothalamic–pituitary insufficiency in patients with previous infectious diseases of the central nervous system (CNS) of different etiologies and mild-to-moderate clinical course.

Design: Patient series. Basal and stimulated (insulin tolerance test) pituitary function testing was performed in 19 patients with previous neuroborreliosis, encephalitis, or meningitis following an interval of between 10 and 56 months (mean 26.1±13.1 months) after the acute event.

Results: Four patients (21%; two males, two females) showed an isolated corticotropic insufficiency (peak cortisol <181.25 µg/l during the insulin tolerance test). Two patients (11%, males) showed borderline gonadotropic insufficiency (basal testosterone between 2.4 and 3.0 µg/l). No patient had somatotropic or thyrotropic insufficiency or evidence for diabetes insipidus; all had prolactin concentrations within the reference range.

Conclusions: Hypothalamic–pituitary dysfunction and especially isolated corticotropic insufficiency may develop in a relevant proportion of patients after infectious diseases of the CNS.

eje-online.org/cgi/content/abstract/158/1/3

[LymeEnigma]

From When to Suspect Lyme, by John D. Bleiweiss, M.D.
www.ariplex.com/lyme/lymbleie.htm

"...Increasingly, I am encountering thyroid disease in LD. A local endocrinologist has remarked to me privately that the incidence of thyroid involvement in LD may be greater than expected from the normal population. A final judgement awaits formal statistical analysis. In many of these patients, the thyroid dysfunction was seen to originate in the pituitary or hypothalmus. Remaining alert to the possibility of thyroid disease is essential because there can be considerable clinical overlap with LD. Subacute thyroiditis is the most prevalent thyroid phenomenon I see in LD. Hypoadrenalism can uncommonly develop. Uncorrected hormonal aberrations can vitiate otherwise effective LD therapy. Like any infection, LD can provoke the onset of hyperglycemia and alter the facility with which diabetes is managed.

"Impaired fertility and a loss of libido is not infrequent in LD. A reversible cause of infertility should be sought and ought to include LD. Reduced sexual interest without an ostensible justification is usually misinterpreted by the partner with predictable social and psychological turmoil. LD infection in the CNS or in the sex glands may be causal. In a few female LD patients, disturbed estrogen and progesterone levels were found. Early "menopause", skipped menses, and heavy menstrual flow represent a few of the perturbations in LD.

"Women with symptomatic LD can experience new onset or heightened PMS (ballistic mood swings and irritability), or perimenstrual headache or cramps...."

[LymeEnigma]

I also posted this under "Treatment Debate": Lyme borreliosis reinfection: might it be explained by a gender difference in immune response?

ORIGINAL ARTICLE
Immunology. 118(2):224-232, June 2006.
Jarefors, Sara 1,2; Bennet, Louise 4,5; You, Elin 1,2; Forsberg, Pia 2,3; Ekerfelt, Christina 1,2; Berglund, Johan 4,5,6; Ernerudh, Jan 1,2

Abstract:
Summary: Lyme borreliosis is a tick-borne disease often manifesting as a circular skin lesion. This cutaneous form of the disease is known as erythema migrans. In a 5-year follow-up study in southern Sweden, 31 of 708 individuals initially diagnosed with erythema migrans and treated with antibiotics were found to be reinfected with Borrelia burgdorferi. Although men and women were tick-bitten to the same extent, 27 of the 31 reinfected individuals were women, all of whom were over 44 years of age. The aim of this study was to determine whether this discrepancy in gender distribution could be a result of differences in immunological response. Twenty single-infected and 21 reinfected women and 18 single-infected and three reinfected men were included in the study. None of the participants showed any sign of an ongoing B. burgdorferi infection, and thus the habitual response was captured. Lymphocytes were separated from blood and stimulated with antigens. The secretion of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-[gamma] and tumour necrosis factor (TNF)-[alpha] was measured by enzyme-linked immunosorbent assay (ELISA), enzyme-linked immunosorbent spot-forming cell assay (ELISPOT) or Immulite. No difference was detected in cytokine secretion between single-infected and reinfected individuals. We also compared the immunological response in men and women, regardless of the number of B. burgdorferi infections. Women displayed a significantly higher spontaneous secretion of all cytokines measured. The ratios of IL-4:IFN-[gamma] and IL-10:TNF-[alpha] were significantly higher in women. Gender differences in immune reactivity might in part explain the higher incidence of reinfection in women. The higher IL-4:IFN-[gamma] and IL-10:TNF-[alpha] ratios seen in women indicate that postmenopausal women have T helper type 2 (Th2)-directed reactivity with impaired inflammatory responses which might inhibit the elimination of spirochetes.

pt.wkhealth.com/pt/re/immu/abstract.00004227-200606000-00009.htm;jsessionid=LfSNJ1nG1vYb8R1pJf1J1WhsthT39lN5mfTpCvbXrnkyjTPNLxNC!802840569!181195629!8091!-1