The 24-Hour Profile of Adrenocorticotropin and Cortisol in Major Depressive Illness*

Abstract

The 24-h profile of plasma ACTH and cortisol levels was determined in 18 men suffering from major depressive illness (8 with unipolar depression and 10 with bipolar depression) as well as in 7 age-matched normal men. Blood was sampled every 15 min. The circadian variation and episodic fluctuations were analyzed for each individual profile. Both unipolar and bipolar depressed patients had higher 24-h mean cortisol levels (P less than 0.01) than normal men, but no significant difference in 24-h mean ACTH level was found. The nadir of cortisol secretion occurred almost 3 h earlier in older normal subjects and patients with unipolar depression, regardless of age, than in younger normal subjects. This shift paralleled a similar advance of the ACTH nadir. Early timing of the quiescent period of ACTH-cortisol secretion was also found in several patients with bipolar depression, but did not reach significance at the group level. The hypercortisolism in the depressed patients was associated with an increase in the magnitude, but not the number, of cortisol secretory episodes. About 90% of the cortisol pulses could be related to a concomitant ACTH pulse in normal subjects as well as in both groups of depressed patients. However, concomitant ACTH and cortisol pulses were less correlated in magnitude in depressed patients than in normal subjects. These results indicate that major depressive illness is associated with disturbances of pituitary-adrenal function. The early timing of the nadir of ACTH-cortisol secretion suggests that disorders of circadian time keeping may characterize major endogenous depression.

Chronic Fatigue Syndrome: Circadian Rhythm and Hypothalamic-Pituitary-Adrenal (HPA) Axis Impairment

“…Moreover, patients with unipolar depression showed a temporal advancement of PRL circadian levels (14)(15).…”

In vivo and in vitro effects of glucocorticoids on lymphocyte proliferation in depression

“…R. Rupprecht, Max-Planck-Institute for Psychiatry, Kraepelinstrasse 10, W-8000 Munich 40, Federal Republic of Germany Depressed patients exhibit a quite remarkable hypercotisolaemia during depressive illness (Linkowski et al 1985(Linkowski et al , 1987 and several lines of evidence suggest an important link between the hypothalamic-pituitary-adrenal axis (HPA) and the immune system (Fauci and Dale 1974;Cupps and Fauci 1982). Glucocorticoids have been shown to inhibit interleukin-1 (IL-1) (Snyder and Unanue 1982) and IL-2 production with subsequently impaired lection-induced blastogenesis (Gillis et al 1979;Cupps and Fauci 1982).…”

A obesidade estaria relacionada ao aumento do volume das adrenais?

“…Com o mesmo tipo de raciocínio, se demonstrou que pacientes com depressão endógena, uma sabida situação de anormalidade do eixo HHA (33,34), se acompanha de aumento do volume das adrenais. Ainda mais, a melhora dos sintomas depressivos é acompanhada por uma diminuição do volume das adrenais para níveis semelhantes aos do grupo controle (35).…”

“…Alguns estudos demonstram que nos estados de depressão maior, onde a hiperatividade do eixo HHA é a mais proeminente anormalidade neuroendócrina (33,34), o volume das glândulas adrenais está aumentado, em aproximadamente 70%, quando comparado com o volume destas, após o tratamento e, também, significativamente maior, quando comparado com voluntários normais (35). Este estudo é concordante com trabalho prévio, que demonstra uma hiperplasia adrenal em pacientes com depressão (36).…”