Mapping of hormones and cortisol responses in patients after Lyme neuroborreliosis

Abstract

Background: Persistent symptoms after treatment for neuroborreliosis are common for reasons mainly unknown. These symptoms are often unspecific and could be caused by dysfunctions in endocrine systems, an issue that has not been previously addressed systematically. We therefore mapped hormone levels in patients with previous confirmed Lyme neuroborreliosis of different outcomes and compared them with a healthy control group.

Methods: Twenty patients of a retrospective cohort of patients treated for definite Lyme neuroborreliosis were recruited 2.3 to 3.7 years (median 2.7) after diagnosis, together with 23 healthy controls. Lyme neuroborreliosis patients were stratified into two groups according to a symptom/sign score. All participants underwent anthropometric and physiological investigation as well as an extensive biochemical endocrine investigation including a short high-dose adrenocorticotropic hormone stimulation (Synacthen) test. In addition to hormonal status, we also examined electrolytes, 25-hydroxy-vitamin D and interleukin-6.

Results: Eight patients (40%) had pronounced symptoms 2-3 years after treatment. This group had a higher cortisol response to synacthen as compared with both controls and the Lyme neuroborreliosis patients without remaining symptoms (p < 0.001 for both comparisons). No other significant differences in the various baseline biochemical parameters, anthropometric or physiological data could be detected across groups.

Conclusions: Apart from a positive association between the occurrence of long-lasting complaints after Lyme neuroborreliosis and cortisol response to synacthen, no corticotropic insufficiency or other serious hormonal dysfunction was found to be associated with remaining symptoms after treatment for Lyme neuroborreliosis.

Figure 1

Symptoms and neurological signs compared to absolute cortisol increment in Lyme neuroborreliosis patients post treatment. Numbers of symptoms and neurological signs at follow up 2.3 to 3.7 years post treatment (x-axis) and absolute cortisol increment (ACI) after 0.25 mg Synacthen^® injection (y-axis) in Lyme neuroborreliosis patients (n = 20). Pearson correlation coefficient r = 0.68; p = 0.001. The post treatment severity (PTS) score was calculated by adding the number of symptoms and pathological neurological signs strictly related to the Lyme neuroborreliosis infection for each patient. The dotted line at score = 4 represents a chosen cut off. Patients with a score above 4 were considered having more pronounced complaints (LNB⁺ n = 8) and below four not pronounced complaints (LNB^- n = 12).