Dexamethasone suppression and multiple hormonal responses (TSH, prolactin and growth hormone) to TRH in some psychiatric disorders

Abstract

Baseline and TRH-induced changes of thyroid stimulating hormone (TSH), prolactin (PRL), and growth hormone (GH) were measured in 15 healthy control subjects and 63 psychiatric inpatients with DSM-III diagnoses of major depression (n = 19), schizophrenic disorder (n = 20), alcohol dependence (n = 10), and adjustment disorder (n = 14); baseline and postdexamethasone cortisol (CS) were also determined 3-6 days after the TRH-challenge. All patients and controls were women of similar mean age, weight, height, and they were free from interfering illness or drugs. Baseline TSH and PRL were lower in depression, TRH-induced TSH and PRL responses were lower in the whole patient group, but most markedly in depression and alcohol dependence. Postdexamethasone CS was significantly higher in depression, schizophrenia and alcohol dependence. Basal GH did not differentiate the subgroups; TRH-induced pathological GH responses were sometimes found in the patient groups. The differences were most marked quantitatively in major depression: a multivariate analysis of variance showed that delta TSH, postdexamethasone CS and delta PRL were the most important variables in separating patients from controls. A discriminant function derived from these variables classified all controls and 18 of 19 depressed patients correctly; however, 25 of the 44 other patients were also classified with depression. It was confirmed that psychiatric patients show significantly more endocrine disturbances than controls, and this was seen not only in major depression but also in at least three other conditions. Further work is needed to identify other neuroendocrine patterns more specific to depressive disorder.

Review: A systematic review of hypothalamic-pituitary-adrenal axis function in schizophrenia: implications for mortality

“…9/16 patients treatment resistant Stokes et al (1984) 13 Drug free !9 days. Recently hospitalized chronic SCH Plasma cortisol 08.30 and 22.00 - Banki et al (1985) 20 Drug free for 2 weeks. Recently hospitalized Plasma cortisol 09.00-10.00 - Gattaz et al (1985) 15 Neuroleptic treated, admitted CSF cortisol 09.00-10.00 - Roy et al (1986) 9 Acutely psychotic newly admitted chronic SCH, tested while drug free for 2 weeks and on fluphenazine Plasma cortisol 20.00 No significant differences in drug-free or medicated patients Whalley et al (1986) Long Zhou et al (1987) 48 Drug free for 1 week.…”

“…Of the 1949 medicated schizophrenia patients, 504 (25.9%) were classified as non-suppressors, suggesting that antipsychotic medications themselves had little effect on DST results. Several studies correlated symptoms such as depressive, negative and positive symptoms with DST outcomes, as Schlesser et al (1980) Mostly inpatients 0/48 (0%) -- Dewan et al (1982) Chronic SCH 6/20 (30%) -No association of post-DEX cortisol with HAM-D or BPRS Rothschild et al (1982) Psychotic inpatients 2/14 (14%) -- Castro et al (1983) Chronic SCH 7/23 (30%) -- Coppen et al (1983) Chronic SCH inpatients 10/46 (22%) -NS associated with negative not positive symptoms Targum (1983) Hospitalized SCH patients 1/14 (7%) - Banki et al (1984) Hospitalized, acutely psychotic 13/34 (38%) -Paranoid SCH < catatonic and hebephrenic Berger et al (1984) Admitted SCH patients 7/23(30%) on admission 4/21 (19%) 7-10 days later -- Hwang et al (1984) SCH inpatients 2/13 (15%) -- Meltzer et al (1984) No details 7/36 (19%) -- Munro et al (1984) Residual SCH outpatients 7/46 (15%) -NS associated with depressive symptoms Nelson et al (1984) Admitted SCH patients 4/14 (29%) -- Rihmer et al (1984) Paranoid SCH 1/20 (5%) -- Sauer et al (1984) Admitted SCH patients 5/20 (25%) -- Sawyer and Jeffries (1984) 20 SCH inpatients 7/20 (35%) -NS associated with melancholic depression not depressed mood Stokes et al (1984) Hospitalized chronic SCH 2/12 (17%) - Banki et al (1985) Recently hospitalized SCH -10/20 (50%) -Baumgartner et al…”

TRH-induced Hormonal Responses: The Effect of Pizotifene and Naloxone

“…The somewhat arbitrary cutoff levels of "normal responses" were: 5 mUll for TSH, 20 ng/ml for PRL, and 4 nglml for GH. These were defined by our laboratory on the basis of previous experience with a larger number of healthy individuals tested with the same methods, and we also used them in another study (4).…”

“…The patients in this study showed a weak, nonsignificant tendency to exhibit some decrease of their plasma levels of a11 three hormones; however, this could be attributed to mere chance. We did not employ maximal stimulation of TRH (15), but preferred to use only 0.2 mg because it could be more sensi• tive to uncover lower pituitary sensitivity, particularly in female patients (4,35).…”