The differential ACTH responses to combined dexamethasone/CRH administration in major depressive and dysthymic disorders

Oshima, Akihiro; Yamashita, Shunsuke; Owashi, Toshimi; Murata, Takuhiko; Tadokoro, C.; Miyaoka, Hiroaki; Kamijima, Kunitoshi; Higuchi, Tetsuya

doi:10.1016/s0022-3956(00)00021-2

Cited by 38 publications

(19 citation statements)

References 17 publications

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“…Furthermore, the DEX/CRH test was shown to be more closely associated with the activity of HPA system (24-h cortisol profiles) than the standard DST in healthy and depressed subjects (Deuschle et al, 1998). We have confirmed the relatively high sensitivity of the DEX/CRH test in Japanese patients with depressive disorder (Oshima et al, 2000;Kunugi et al, 2004). These findings indicate that the DEX/CRH test is a useful laboratory tool to monitor HPA axis abnormalities in depressed patients in clinical practice.…”

Section: Introductionsupporting

confidence: 61%

“…There was no evidence for significant effects on hormonal outcomes due to a 1 h difference between the two protocols (data not shown), combining the data from the two protocols. According to our previous reports (Oshima et al, 2000;Kunugi et al, 2004), the plasma concentrations of ACTH and cortisol peak at approximately 60 min after infusion of CRH, indicating that the A 60 and C 60 values reflect the maximal responses to CRH. The area under the time curve (AUC, arbitrary unit) was calculated according to the trapezoidal rule (A auc for ACTH and C auc for cortisol).…”

Section: Data Presentation For Hormonal Measuresmentioning

confidence: 56%

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Assessment of the Dexamethasone/CRH Test as a State-Dependent Marker for Hypothalamic-Pituitary-Adrenal (HPA) Axis Abnormalities in Major Depressive Episode: A Multicenter Study

Kunugi

Ida

Owashi

et al. 2005

Neuropsychopharmacol

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189

108

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There is compelling evidence for the involvement of hypothalamic-pituitary-adrenal (HPA) axis abnormalities in depression. Growing evidence has suggested that the combined dexamethasone (DEX)/corticotropin-releasing hormone (CRH) test is highly sensitive to detect HPA axis abnormalities. We organized a multicenter study to assess the DEX/CRH test as a state-dependent marker for major depressive episode in the Japanese population. We conducted the DEX/CRH test in 61 inpatients with major depressive episode (Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV)) and 57 healthy subjects. In all, 35 patients were repeatedly assessed with the DEX/CRH test on admission and before discharge. The possible relationships between clinical variables and the DEX/ CRH test were also examined. Significantly enhanced pituitary-adrenocortical responses to the DEX/CRH test were observed in patients on admission compared with controls. Such abnormalities in patients were significantly reduced after treatment, particularly in those who underwent electroconvulsive therapy (ECT) in addition to pharmacotherapy. Age and female gender were associated with enhanced hormonal responses to the DEX/CRH test. Severity of depression correlated with DEX/CRH test results, although this was explained, at least in part, by a positive correlation between age and severity in our patients. Medication per se was unrelated to DEX/CRH test results. These results suggest that the DEX/CRH test is a sensitive state-dependent marker to monitor HPA axis abnormalities in major depressive episode during treatment. Restoration from HPA axis abnormalities occurred with clinical responses to treatment, particularly in depressed patients who underwent ECT.

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Section: Introductionsupporting

confidence: 61%

Section: Data Presentation For Hormonal Measuresmentioning

confidence: 56%

Assessment of the Dexamethasone/CRH Test as a State-Dependent Marker for Hypothalamic-Pituitary-Adrenal (HPA) Axis Abnormalities in Major Depressive Episode: A Multicenter Study

Kunugi

Ida

Owashi

et al. 2005

Neuropsychopharmacol

Self Cite

189

108

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“…However, Heim et al [41] reported that patients with depression with early abuse appear to show evidence of reduced basal cortisol levels compared to subjects with depression in the absence of early abuse. Some studies have reported that patients with dysthymia chronic depression display less alteration of the HPA system and are likely not to respond to treatment [42] . The current study may contribute to an understanding of the underlying reason for the observation that approximately half of depressed patients reduced suppression on the DST.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports have suggested that high-risk probands exhibit abnormal DEX/CRH test results as a result of impaired coping stress [8,42,44,45] . Further studies will be needed to examine the relationship between high-risk probands and SLEs.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Suppression of Adrenocorticotropic Hormone and Cortisol Responses to Hypothalamic-Pituitary-Adrenal Function and Thyrotropin-Releasing Hormone Tests after Stressful Life Events in Patients with Major Depressive Disorder

Hikichi

Akiyoshi²,

Ichioka³

et al. 2007

Neuropsychobiology

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Background: It is commonly believed that there exists a relationship between the outcome of thyrotropin-releasing hormone (TRH) test, the combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) test and stressful life events (SLEs) in major depressive disorder. Objective: SLEs influence the TRH and DEX/CRH tests in major depressive disorder when administered at the time of admission and improvement. Methods: The TRH and DEX/CRH tests were administered to patients hospitalized for major depressive disorders – on the 4th through the 7th hospital day and at the time of improvement. We measured ΔMAX TSH, ΔMAX ACTH, ACTH AUC, ΔMAX cortisol, cortisol AUC, ΔMAX ACTH/ΔMAX TSH and ΔMAX cortisol/ΔMAX TSH. Results: SLEs were significantly negatively associated with ΔMAX ACTH, ACTH AUC and cortisol AUC at the time of admission. However, these relationships lost significance at the time of improvement. The sample (41 patients at the time of admission, 18 patients at the time of improvement) was relatively small, which may have contributed to false-negative results. Conclusion: SLEs may be negatively associated with the outcome of the DEX/CRH tests in major depressive disorder. The hypothalamic-pituitary-adrenal axis in the DEX/CRH test was modulated by SLEs.

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“…Acredita-se que a hiperatividade do eixo estaria associada tanto ao aumento da liberação de AVP quanto à maior sensibilidade do eixo HHA à AVP (46,47).…”

Section: Depressão Maiorunclassified

Estados de pseudo-Cushing

Romanholi

Salgado

2007

Arq Bras Endocrinol Metab

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Síndromes de pseudo-Cushing são um grupo heterogêneo de doenças, incluindo alcoolismo, anorexia nervosa, obesidade visceral e depressão, que compartilham muitas das características clínicas e bioquímicas da síndrome de Cushing. Os mecanismos responsáveis para a gênese da síndrome de pseudo-Cushing são fracamente compreendidos. Tem sido sugerido que o hipercortisolismo da síndrome de pseudo-Cushing pode ser resultante do aumento da secreção do hormônio liberador de corticotrofina (CRH) hipotalâmico no contexto de um eixo hipotálamo-hipofisário-adrenal que, de outra maneira, está normalmente constituído. A sobreposição substancial entre as características clínicas e laboratoriais entre muitos pacientes com síndrome de Cushing e aqueles com síndrome de pseudo-Cushing pode tornar o diagnóstico diferencial difícil. Distinguir entre síndrome de pseudo-Cushing e síndrome de Cushing verdadeira é crítico para se prevenir o tratamento desnecessário e potencialmente prejudicial de tais pacientes. Esta breve revisão sumariza os principais eventos patofisiológicos das síndromes de pseudo-Cushing e fornece uma estratégia útil para o seu diagnóstico diferencial.

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The differential ACTH responses to combined dexamethasone/CRH administration in major depressive and dysthymic disorders

Cited by 38 publications

References 17 publications

Assessment of the Dexamethasone/CRH Test as a State-Dependent Marker for Hypothalamic-Pituitary-Adrenal (HPA) Axis Abnormalities in Major Depressive Episode: A Multicenter Study

Assessment of the Dexamethasone/CRH Test as a State-Dependent Marker for Hypothalamic-Pituitary-Adrenal (HPA) Axis Abnormalities in Major Depressive Episode: A Multicenter Study

Enhanced Suppression of Adrenocorticotropic Hormone and Cortisol Responses to Hypothalamic-Pituitary-Adrenal Function and Thyrotropin-Releasing Hormone Tests after Stressful Life Events in Patients with Major Depressive Disorder

Estados de pseudo-Cushing

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