Amsterdam J D, Maislin G, Winokur A, Kling M, Gold P
Arch Gen Psychiatry. 1987 Sep;44(9):775-81. doi: 10.1001/archpsyc.1987.01800210019003.
It has been suggested that limbic system-hypothalamic "overdrive" may be the underlying mechanism causing an augmented secretion of corticotropin releasing hormone (CRH), heightened adrenocortical responsiveness to corticotropin (adrenocorticotropic hormone) (ACTH), and alteration in cortisol feedback regulatory mechanisms as demonstrated by the dexamethasone suppression test. We examined pituitary and adrenocortical responses after morning administration of ovine CRH (oCRH) in 26 depressed patients and 11 healthy volunteers. Basal plasma ACTH concentrations were similar in both groups, whereas patients had a significantly diminished cumulative ACTH response after administration of oCRH. In contrast, basal total cortisol concentrations and cumulative cortisol responses to oCRH were similar in depressed patients and controls. Patients with melancholic features demonstrated the most profound ACTH blunting after oCRH, whereas patients separated according to dexamethasone suppression test results had similar ACTH and cortisol responses to oCRH. The present results extend data from prior studies utilizing oCRH in the evening and demonstrate a dysregulation of the functional integrity of the hypothalamic-pituitary-adrenocortical axis in depressive illness after a morning oCRH test at both central and peripheral hypothalamic-pituitary-adrenocortical axis sites.
有人提出，边缘系统 - 下丘脑的“过度驱动”可能是导致促肾上腺皮质激素释放激素（CRH）分泌增加、肾上腺皮质对促肾上腺皮质激素（ACTH）反应性增强以及如地塞米松抑制试验所示的皮质醇反馈调节机制改变的潜在机制。我们检测了26名抑郁症患者和11名健康志愿者在早晨给予羊促肾上腺皮质激素释放激素（oCRH）后的垂体和肾上腺皮质反应。两组的基础血浆促肾上腺皮质激素浓度相似，但患者在给予oCRH后累积促肾上腺皮质激素反应明显减弱。相比之下，抑郁症患者和对照组的基础总皮质醇浓度以及对oCRH的累积皮质醇反应相似。具有忧郁特征的患者在给予oCRH后促肾上腺皮质激素反应减弱最为明显，而根据地塞米松抑制试验结果分组的患者对oCRH的促肾上腺皮质激素和皮质醇反应相似。目前的结果扩展了先前在晚上使用oCRH的研究数据，并表明在早晨进行oCRH试验后，抑郁症患者下丘脑 - 垂体 - 肾上腺皮质轴的功能完整性在中枢和外周下丘脑 - 垂体 - 肾上腺皮质轴部位均存在失调。
