Enhanced Dexamethasone Suppression of Plasma Cortisol in Adult Women Traumatized by Childhood Sexual Abuse

Stein, Murray B.; Yehuda, Rachel; Koverola, Catherine; Hanna, Cindy

doi:10.1016/s0006-3223(96)00489-1

Cited by 308 publications

(161 citation statements)

References 20 publications

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“…The findings are also generally similar to reports of decreased morning cortisol levels in women with child abuse experience, suggesting that different types of early adversity might be associated with similar HPA axis alterations (Stein et al, 1997;Heim et al, 2001). Our findings are not in accord with findings by Nicolson (2004) who reported increased salivary cortisol concentrations at 8 a.m. in adult men with parental loss.…”

Section: Commentsupporting

confidence: 85%

Decreased cortisol awakening response after early loss experience

Meinlschmidt

Heim

2005

Psychoneuroendocrinology

141

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SummaryEarly loss experience (ELE) due to death or separation is a major risk factor for the development of several psychiatric and physical disorders in adulthood. Few studies have focused on the effects of ELE on neuroendocrine systems, which might mediate this risk in part. The goal of this study was to evaluate salivary cortisol responses to awakening in individuals with and without ELE. A total of 95 healthy college students (29 men, 66 women) completed a questionnaire on ELE and were instructed to collect saliva immediately after awakening and 30 minutes later. Fifty-five of the 95 subjects reported having experienced the separation or divorce of their parents and/or the death of a close relative before the age of 14 years. Subjects with such ELE exhibited decreased salivary cortisol responses to awakening compared to subjects without ELE (net increase: 4.78 nmol/l versus 9.83 nmol/l; t 93 =2.88, p=.005). The effect was most pronounced in individuals who experienced multiple types of ELE, while there were no sex differences. In conclusion, ELE appears to be associated with decreased salivary cortisol responses to awakening. Low cortisol awakening responses are believed to reflect altered dynamics of the hypothalamic-pituitary-adrenal (HPA) axis, possibly conferring risk for certain stress-related disorders.[200 words]

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Section: Commentsupporting

confidence: 85%

Decreased cortisol awakening response after early loss experience

Meinlschmidt

Heim

2005

Psychoneuroendocrinology

141

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“…There has been very limited investigation of individuals manifesting primarily with dissociative psychopathology, and the few HPA axis studies in DD are largely confounded by comorbidity. A study of 19 adult women with childhood sexual abuse reported hypersuppression in response to low-dose dexamethasone, (Stein et al 1997); however 13 of the women had PTSD and 15 had DD, not permitting a dissection of the two diagnoses. On the other hand, a study of adult Dissociative Identity Disorder patients with extensive PTSD comorbidity reported resistance to dexamethasone suppression .…”

Section: Introductionmentioning

confidence: 99%

Hypothalamic-Pituitary-Adrenal Axis Function in Dissociative Disorders, Post-Traumatic Stress Disorder, and Healthy Volunteers

Simeon

Knutelska

Yehuda³

et al. 2007

Biological Psychiatry

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144

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“…Increased hypothalamic CRF has also been inferred from a number of studies that have found elevated cortisol levels in PTSD (De Bellis et al, 1999;Lemieux and Coe, 1995;Liberzon et al, 1999;Maes et al, 1998;Pitman and Orr, 1990). Despite possible elevated hypothalamic CRF activity, PTSD subjects in a large number of studies have been found to have either normal (Baker et al, 1999) or decreased 24-h urinary cortisol (Mason et al, 1986;Yehuda et al, 1995;Yehuda et al, 1990), normal (Kellner et al, 2002) or decreased plasma cortisol (Jensen et al, 1997;Yehuda et al, 1996b), increased lymphocyte glucocorticoid receptors (Yehuda et al, 1991), normal (Kosten et al, 1990) or increased suppression of cortisol in response to dexamethasone (Goenjian et al, 1996;Grossman et al, 1996;Stein et al, 1997;Yehuda et al, 1993), and a buffered ultradian pattern of cortisol release (Yehuda et al, 1996b). Most of these findings are consistent with the hypothesis that PTSD is associated with enhanced negative feedback of the HPA axis, or reduced adrenal output, or a combination of these two mechanisms (for a review, see Yehuda, 2002).…”

Section: Introductionmentioning

confidence: 99%

Delta Sleep Response to Metyrapone in Post-Traumatic Stress Disorder

Neylan

Lenoci

Maglione

et al. 2003

Neuropsychopharmacol

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Metyrapone blocks cortisol synthesis, which results in the stimulation of hypothalamic cortiocotropin-releasing factor (CRF) and a reduction in delta sleep. We examined the effect of metyrapone administration on endocrine and sleep measures in male subjects with and without chronic PTSD. We hypothesized that metyrapone would result in a decrease in delta sleep and that the magnitude of this decrease would be correlated with the endocrine response. Finally, we utilized the delta sleep response to metyrapone as an indirect measure of hypothalamic CRF activity and hypothesized that PTSD subjects would have decreased delta sleep at baseline and a greater decrease in delta sleep induced by metyrapone. Three nights of polysomnography were obtained in 24 male subjects with combatrelated PTSD and 18 male combat-exposed normal controls. On day 3, metyrapone was administered during normal waking hours until habitual sleep onset preceding night 3. Endocrine responses to metyrapone were measured in plasma obtained the morning following sleep recordings, the day before and after administration. Repeated measures ANOVAs were conducted to compare the endocrine and sleep response to metyrapone in PTSD and controls. PTSD subjects had significantly less delta sleep as indexed by stages 3 and 4, and total delta integrated amplitude prior to metyrapone administration. There were no differences in premetyrapone cortisol or ACTH levels in PTSD vs controls. PTSD subjects had a significantly decreased ACTH response to metyrapone compared to controls. Metyrapone caused an increase in awakenings and a marked decrease in quantitative measures of delta sleep that was significantly greater in controls compared to PTSD. The decline in delta sleep was significantly associated with the magnitude of increase in both 11-deoxycortisol and ACTH. The results suggest that the delta sleep response to metyrapone is a measure of the brain response to increases in hypothalamic CRF. These data also suggest that the ACTH and sleep EEG response to hypothalamic CRF is decreased in PTSD.

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Enhanced Dexamethasone Suppression of Plasma Cortisol in Adult Women Traumatized by Childhood Sexual Abuse

Cited by 308 publications

References 20 publications

Decreased cortisol awakening response after early loss experience

Decreased cortisol awakening response after early loss experience

Hypothalamic-Pituitary-Adrenal Axis Function in Dissociative Disorders, Post-Traumatic Stress Disorder, and Healthy Volunteers

Delta Sleep Response to Metyrapone in Post-Traumatic Stress Disorder

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