Interleukin 6 and cortisol levels changes during cardiopulmonary exercise test in patients with sarcoidosis

E. A. Pappa, S. Nanas, A. Papamichalopoulos, A. Samakovli, T. Kyprianou, G. Mastorakos, M. Triadafilopoulou, K. Konstantinou, V. Kotsovoulou, I. Economidou, C. Roussos

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Current evidence suggests that autoimmune phenomena are involved in the pathogenesis of sarcoidosis, a chronic multisystem, granulomatous disease. A defective hypothalamic-pituitary-adrenal (HPA) axis characterizes autoimmune diseases. Exogenously administered and endogenous exercise-induced interleukin (IL) 6 are known to stimulate the HPA axis. To examine the HPA axis responsiveness in patients with sarcoidosis, we measured IL-6 and cortisol levels under basal conditions and during exercise. METHOD: We submitted 26 untreated patients with sarcoidosis, 9 patients treated with corticosteroids and 10 normal controls to maximal cardiopulmonary exercise testing. We measured IL-6 and cortisol levels in blood samples drawn before, at peak exercise and 15 min after exercise. IL-6 was measured by a specific ELISA and cortisol by a RIA. RESULTS: Interleukin 6 levels at baseline were significantly higher (P < 0.05) in untreated patients (mean±SD 3.12±2.93 pg/mL) and in patients receiving corticosteroids (3.2±5.96 pg/mL) than in controls (1.03±0.80 pg/mL). Cortisol levels at baseline were comparable in all groups (111.54+↑8.38, 105.57±71.43 and 106.00±35.20 ng/mL, respectively). Interleukin 6 levels were significantly increased (P < 0.05) at peak and 15 min after exercise in untreated patients (4.02±3.05 and 4.46±4.41 pg/mL, respectively) and controls (1.79±1.24 and 1.60±1.16 pg/mL, respectively). Similarly, cortisol levels were significantly increased (P<0.05) at peak and 15 min after exercise both in untreated patients (162.60±91.40 and 157.74±61.80 ng/mL, respectively) and controls (133.22±72.22 and 152.00±36.97 ng/mL, respectively). Cortisol and IL-6 levels did not increase during exercise in patients receiving corticosteroids. CONCLUSIONS: We conclude that in sarcoidosis the HPA axis is hyporesponsive to the chronically increased levels of endogenous IL-6, although it can still be activated by exercise. This might indicate a direct and/or indirect involvement of a defective HPA axis in the pathogenesis of sarcoidosis. Alternatively, it might indicate a resetting of the HPA axis to the chronically elevated levels of IL-6.

Original languageEnglish
Pages (from-to)56-61
Number of pages6
JournalArchives of Hellenic Medicine
Issue number1
Publication statusPublished - 1999


  • Cortisol
  • Exercise
  • Hypothalamic-pituitary-adrenal axis
  • Interleukin 6
  • Sarcoidosis


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