Rabin D S, Schmidt P J, Campbell G, Gold P W, Jensvold M, Rubinow D R, Chrousos G P
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
J Clin Endocrinol Metab. 1990 Nov;71(5):1158-62. doi: 10.1210/jcem-71-5-1158.
Patients with primary affective disorders, such as melancholic depression and anorexia nervosa, frequently have a hyperactive hypothalamic-pituitary-adrenal (HPA) axis, characterized by hypersecretion of CRH and a blunted ACTH response to exogenous CRH. Premenstrual syndrome (PMS) is a luteal phase dysphoric disorder characterized by primarily affective and behavioral disturbances. HPA axis function was compared in PMS patients and control women, respectively, diagnosed by DSM3-R criteria or found to have no current psychiatric disorders, determined by the Schedule for Affective Disorders and Schizophrenia-Lifetime Interview. Urinary free cortisol excretion was the same in PMS and normal women, and no differences in urinary free cortisol excretion between the follicular and luteal phases occurred in either group. Two HPA axis abnormalities, however, were noted when PMS patients were compared to normal women. First, basal evening cortisol concentrations in plasma were significantly decreased, while the time-integrated response of plasma cortisol to ovine (o) CRH was significantly increased. Second, the negative correlation between time-integrated plasma ACTH and cortisol responses to oCRH and basal luteal progesterone concentrations present in normal control women was not seen in the PMS patients. These changes in basal and oCRH-stimulated plasma cortisol levels in association with normal urinary free cortisol excretion suggest that women with PMS might have transient or episodic disturbances of their HPA axis, which appear adequately corrected by this system's servomechanisms. This probably explains the maintenance of regular menstrual cycles in PMS patients, which contrasts with the irregular menses observed in patients with depression, anorexia nervosa, or women who participate in chronic strenuous exercise.
患有原发性情感障碍的患者，如抑郁性抑郁症和神经性厌食症，下丘脑 - 垂体 - 肾上腺（HPA）轴常常过度活跃，其特征为促肾上腺皮质激素释放激素（CRH）分泌过多以及促肾上腺皮质激素（ACTH）对外源性CRH反应迟钝。经前综合征（PMS）是一种黄体期烦躁障碍，主要特征为情感和行为紊乱。分别根据《精神疾病诊断与统计手册第三版修订本》（DSM3 - R）标准诊断的经前综合征患者和对照女性，或通过情感障碍和精神分裂症问卷 - 终生访谈确定目前无精神疾病的女性，对其HPA轴功能进行了比较。经前综合征患者和正常女性的尿游离皮质醇排泄量相同，两组在卵泡期和黄体期的尿游离皮质醇排泄量均无差异。然而，将经前综合征患者与正常女性相比，发现了HPA轴的两个异常情况。首先，血浆中基础夜间皮质醇浓度显著降低，而血浆皮质醇对羊（o）CRH的时间积分反应显著增加。其次，正常对照女性中存在的血浆ACTH时间积分与皮质醇对oCRH的反应和基础黄体期孕酮浓度之间的负相关关系在经前综合征患者中未观察到。基础和oCRH刺激的血浆皮质醇水平的这些变化与正常尿游离皮质醇排泄量相关，表明经前综合征女性的HPA轴可能存在短暂或发作性紊乱，而该系统的伺服机制似乎对此进行了充分纠正。这可能解释了经前综合征患者月经周期规律的维持，这与抑郁症、神经性厌食症患者或参与长期剧烈运动的女性中观察到的月经不规律形成对比。
