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Aktuelle Rheumatologie 2013; 38(04): 218-225
DOI: 10.1055/s-0033-1351302
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Störungen von Hormonsystemen bei Autoimmunerkrankungen – gut oder böse?

Alteration of Hormonal Systems in Autoimmune Disorders – Good or Bad?
G. Pongratz
1   Klinik und Poliklinik für Innere Medizin I, Labor für experimentelle Rheumatologie und Neuroendokrino-Immunologie, Universitätsklinikum Regensburg
,
R. H. Straub
1   Klinik und Poliklinik für Innere Medizin I, Labor für experimentelle Rheumatologie und Neuroendokrino-Immunologie, Universitätsklinikum Regensburg
› Author Affiliations
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Publication History

Publication Date:
13 August 2013 (online)

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Zusammenfassung

Veränderungen des Hormonsystems bei chronisch-entzündlichen Erkrankungen wurden sowohl beim Mensch als auch im Tiermodell beobachtet. Es hat sich jedoch im Laufe der Jahre gezeigt, dass diese Veränderungen nicht separiert betrachtet werden können. Sie sind ein Ausdruck einer generalisierten Neukonfiguration der Körpersysteme (Hormonsystem, Nervensystem und Immunsystem) im Rahmen entzündlicher Prozesse. Diese Übersichtsarbeit versucht den tieferen Sinn dieser Anpassungsreaktion, hier auch genannt „Entzündungskonfiguration“ zu charakterisieren. Diese Anpassungsreaktion dient v. a. einem Zweck, der optimalen Bekämpfung eines infektiösen „Eindringlings“. Dies wird durch 2 Maßnahmen erreicht: 1) Je nach Dauer der Entzündung kommt es zu einer zunehmenden Abkopplung und Verselbständigung der lokalen Entzündung von einer systemischen Regulation, wobei lokale entzündungsfördernde Mechanismen überwiegen. 2) Da das aktivierte Immunsystem erhebliche Mengen an energiereichen Substraten verbraucht, ist die Sicherstellung des Energienachschubs von entscheidender Bedeutung. Dies wird ebenfalls durch die Entzündungskonfiguration der Körpersysteme erreicht. Diese Mechanismen wurden während der Evolution zum Zweck der akuten Abwehr von „Eindringligen“ entwickelt. Allerdings hat der Körper keine Methoden zur Verfügung, diese Vorgänge abzuschalten, solange ein Grund für die Entzündung vorhanden ist (z. B. persistentes Autoantigen, Defekt von immunregulatorischen Mechanismen, immunologischer Toleranzverlust). So kommt es zu weitreichenden negativen Auswirkungen (Katabolie, Kachexie, Bluthochdruck, Wasserretention, diabetogene Stoffwechsellage, usw.). Anhand des Beispiels der veränderten hor­monalen Regulation bei Patienten mit rheumatoider Arthritis (HPA-Achse und Sexualsteroide), sollen diese Konzepte dargestellt werden.

Abstract

Alterations of hormonal systems during chronic inflammatory states have been observed in human disease and animal models of diseases. Emerging concepts over the last decades show that these alterations may not be regarded as separate. They are merely the consequence of a generalised reconfiguration of regulatory body systems during inflammation (hormonal, nervous, and immune). This review tries to characterise the deeper meaning of this adaptation process, which is called “inflammatory configuration”. This adaptational process during inflammation is important for optimisation of the fight against infectious “intruders”. This goal is reached first and foremost by two measures: (i) depending on the duration of inflammation, the local inflammatory process gets more and more independent from systemic regulation so that local proinflammatory mechanisms prevail; (ii) since the activated immune system needs a lot of energy, securing the energy supply is of outstanding importance, which is part of the inflammatory reconfiguration of the body systems. These mechanisms have been developed during evolution for one reason: the acute fight against infectious intruders. Therefore, the organism has no means to end these processes as long as a reason for inflammation remains (e. g. persisting autoantigen, defects in regulatory mechanisms, loss of tolerance). Due to the chronic catabolic state (continuous energy supply to the immune system) and the ongoing propagation of local inflammation (local tissue destruction), several negative consequences arise (catabolism, cachexia, high blood pressure, water retention, diabetogenic metabolic state, etc.). Using hormonal dysregulation as an example (HPA axis and sex hormones), we explain these concepts in detail in this review.

Schlüsselwörter

Autoimmunerkrankung - Hormonsystem - Endokrinoimmunologie - HPAAchse - Sexualhormone

Key words

autoimmune diseases - endocrine system - endocrinoimmunology - HPA axis - sex hormones
 

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