Integrated Assessment of Endocrine Axes in Chronic Chagas Disease Using a Combined Stimulation Test
DOI:
https://doi.org/10.36557/2674-9432.2026v5n5p740-754%20Keywords:
Chagas disease, hypothalamic-pituitary axis, adrenal reserve, thyroid hormones, endocrine function, combined stimulation testAbstract
Background: Chronic Chagas disease (CD) is characterized by cardiac and digestive manifestations, but its potential effects on neuroendocrine function remain poorly understood. This study aimed to evaluate the integrity of the hypothalamic-pituitary-target gland axes in patients with chronic CD using a combined hypothalamic stimulation test.
Methods: In this prospective study, 15 patients with chronic CD (five with the indeterminate form and ten with the cardiac form) underwent simultaneous stimulation with corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone (TRH), and luteinizing hormone-releasing hormone (LHRH/GnRH). Dynamic responses of the hypothalamic-pituitary-adrenal (HPA), hypothalamic-pituitary-thyroid (HPT), hypothalamic-pituitary-gonadal (HPG), and prolactin axes were evaluated by serial measurements of ACTH, cortisol, TSH, prolactin, FSH, LH, thyroid hormones, testosterone, estradiol, and reverse T3.
Results: Pituitary function was preserved in all patients, as demonstrated by normal ACTH and TSH responses to CRH and TRH stimulation, respectively. Two patients exhibited reduced cortisol responses despite normal basal cortisol concentrations, suggesting decreased adrenocortical reserve. Reduced free thyroxine (FT4) levels were observed in eight patients, while low T3 syndrome was identified in three patients. Reverse T3 concentrations remained within the normal range in all cases. Prolactin responses were preserved in all but one patient, and basal hyperprolactinemia was observed in two men. Baseline testosterone concentrations and LH responses were normal in male patients, whereas isolated abnormalities in FSH responses and estradiol levels were identified without evidence of clinically significant gonadal dysfunction.
Conclusions: Chronic CD is not associated with generalized dysfunction of the hypothalamic-pituitary endocrine axes. Preserved pituitary responses indicate intact central neuroendocrine regulation, whereas reduced adrenocortical reserve and alterations in thyroid hormone metabolism suggest selective peripheral endocrine adaptations. These findings expand current knowledge of the endocrine manifestations of chronic CD and support further investigation of their clinical significance in larger patient populations.
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Copyright (c) 2026 Alejandro Marcel Hasslocher-Moreno, Carmen Rosemeri Copetti , Mauro Tendrich
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