Scientific correspondence
The pituitary-adrenal axis in idiopathic retinal vasculitis
H E Palmera b, M R Stanforda b, C Lowyc, M J Wheelerc, G R Wallaceb, E M Grahama
a Medical
Eye Unit, St Thomas's Hospital, London, b Department of
Ophthalmology, c Department of Clinical Chemistry and
Endocrinology
Correspondence to: Miss Helen Palmer, Medical Eye Unit, St Thomas's Hospital, London SE1 7EH
Accepted for publication 27 July 1999
AIMS
To determine
whether patients with idiopathic retinal vasculitis have altered
production of cortisol and dehydroepiandrosterone sulphate (DHEA-S),
and whether differences in these variables occur between those who are
sensitive (SS) and resistant (SR) to steroids.
METHODS20 patients
with retinal vasculitis (off treatment) and 10 control subjects were
prospectively recruited. Morning cortisol and DHEA-S levels were
measured, and cortisol secretion rates and short synacthen tests (SST)
carried out in patients before treatment, when on prednisolone 20 mg/day, and in controls.
RESULTSThere were no
differences in any variables between patients and controls. For retinal
vasculitis patients pretreatment, the SST was lower in SR patients
(p=0.02). More of the SR patients had ischaemic retinal vasculitis (
p<0.001).
CONCLUSIONSCortisol
and DHEA-S are not involved in the pathogenesis of retinal vasculitis.
SR in retinal vasculitis may be associated with a defective
hypothalamic-pituitary-adrenal axis.
© 1999 by British Journal of Ophthalmology
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