Helicobacter pylori infection and the hypothalamic–pituitary axis: association with cortisol and thyroid-stimulating hormone levels in adults

Nedaa  Husein; Muna M.  Abbas; Dania  Basha; Dima  Tareq Owais; Nameer Amer  Hanineh-Halasa

doi:10.18502/ijm.v18i3.21653

Nedaa Husein Department of Allied Medical Sciences, Zarqa University College, Al-Balqa Applied University, Zarqa, Jordan
Muna M. Abbas Department of Allied Medical Sciences, Zarqa University College, Al-Balqa Applied University, Zarqa, Jordan
Dania Basha Department of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan
Dima Tareq Owais Department of Genetics, Precision Medical Laboratory Group, Amman, Jordan
Nameer Amer Hanineh-Halasa Department of Internal Medicine, Royal Medical Services (RMS), Amman, Jordan

DOI: https://doi.org/10.18502/ijm.v18i3.21653

Keywords: Helicobacter pylori; Cortisol; Thyroid-stimulating hormone; Hypothalamic–pituitary axis; Neuroendocrine reg- ulation

Abstract

Background and Objectives: Helicobacter pylori is a common chronic bacterial infection primarily associated with gastro- intestinal disease. Increasing evidence suggests that H. pylori may also exert systemic effects beyond the stomach, including possible modulation of neuroendocrine pathways. This study aimed to investigate the association between H. pylori infection and alterations in serum cortisol and thyroid-stimulating hormone (TSH) levels as indicators of hypothalamic-pituitary-adre- nal (HPA) and hypothalamic-pituitary-thyroid (HPT) axis activity.

Materials and Methods: In this case-control study, 850 adults were enrolled, including 425 H. pylori-positive cases and 425

pylori-negative controls. Active H. pylori infection was determined using a monoclonal stool antigen test (HpSA). Fast- ing venous blood samples were collected between 08:00 and 10:00 AM under standardized conditions. Serum cortisol and TSH levels were measured using validated immunoassays. Group comparisons, correlation analysis, sex-stratified subgroup analysis, and receiver operating characteristic (ROC) curve analysis were performed.

Results: H. pylori-positive participants had significantly higher serum cortisol levels and lower TSH levels compared with controls (both p < 0.001). A significant inverse correlation between cortisol and TSH was observed only in infected partici- pants (r = -0.41, p < 0.001). These hormonal alterations were evident in both sexes. ROC analysis showed moderate discrim- inatory performance for cortisol (AUC = 0.71) and fair-to-moderate performance for TSH (AUC = 0.67).

Conclusion: H. pylori infection was significantly associated with elevated cortisol levels, reduced TSH levels, and an inverse relationship between both hormones in adults. These findings suggest that chronic H. pylori infection may influence both HPA and HPT axis regulation and support further investigation into its systemic neuroendocrine effects.