New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA; James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, 130 West Kingsbridge Road, Bronx, New York, NY, USA.
J Affect Disord. 2013 Dec;151(3):1108-12. doi: 10.1016/j.jad.2013.06.049. Epub 2013 Jul 15.
The hypothalamic-pituitary-adrenal (HPA) axis is dysfunctional in a subgroup of mood disorders.
We compared cortisol and adrenocorticotropic hormone (ACTH) responses in major depression and healthy volunteers to the combined dexamethasone suppression-corticotrophin-releasing hormone stimulation (DEX-CRH) test. Unlike other published studies, the study patients were medication-free and the healthy volunteers did not have first-degree relatives with a mood or psychotic disorder. Demographics, DSM-IV diagnoses and other clinical parameters were evaluated in major depressive disorder (MDD) and healthy control groups. Participants received an oral dose of 1.5mg dexamethasone at 11 pm the day before CRH administration. On the following day, at 3 pm, 100 µg of ovine CRH was infused. Blood samples for determination of cortisol and ACTH were collected every 15 min from 3 pm to 4:15 pm. Cortisol and ACTH responses were calculated as areas under the curve.
Controlling for age, baseline (i.e., post-dexamethasone) ACTH levels were higher in depressed patients compared to controls (p=0.01). There was a trend for higher ACTH responses in depressed patients compared to the control group (p=0.08). In depressed patients, cortisol and ACTH responses correlated positively with age, duration of illness and number of hospitalizations.
Because of the cross-sectional study design we can only evaluate the nature of potential HPA axis disturbances that were present in patients when they are acutely depressed.
Feedback inhibition of ACTH secretion by cortisol is compromised in MDD, and this is independent of an age effect on the HPA axis function.
下丘脑-垂体-肾上腺（HPA）轴在情绪障碍的亚组中功能失调。
我们比较了大 抑郁症患者和健康志愿者对联合地塞米松抑制-促皮质素释放激素刺激（DEX-CRH）试验的皮质醇和促肾上腺皮质激素（ACTH）反应。与其他已发表的研究不同，研究患者未服用药物，健康志愿者的一级亲属中没有情绪或精神病障碍。在重性抑郁症（MDD）和健康对照组中评估了人口统计学、DSM-IV 诊断和其他临床参数。参与者在前一天晚上 11 点口服 1.5mg 地塞米松，然后在 CRH 给药的第二天下午 3 点输注 100µg 羊促皮质素。从下午 3 点到 4 点 15 分，每隔 15 分钟采集一次血液样本，以测定皮质醇和 ACTH。皮质醇和 ACTH 反应的计算方法为曲线下面积。
控制年龄后，抑郁患者的基础（即地塞米松后）ACTH 水平高于对照组（p=0.01）。与对照组相比，抑郁患者的 ACTH 反应呈上升趋势（p=0.08）。在抑郁患者中，皮质醇和 ACTH 反应与年龄、疾病持续时间和住院次数呈正相关。
由于采用横断面研究设计，我们只能评估患者在急性抑郁时 HPA 轴功能紊乱的性质。
MDD 患者的 ACTH 分泌受皮质醇的反馈抑制受损，这与 HPA 轴功能的年龄效应无关。
