Lopez J F, Kathol R G, Jaeckle R S, Meller W
Biol Psychiatry. 1987 Feb;22(2):153-66. doi: 10.1016/0006-3223(87)90226-5.
Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, demonstrated by failure to suppress cortisol secretion after dexamethasone, is found in approximately 50% of patients with major depression (MD). In this study, we examined the response of adrenocorticotrophic hormone (ACTH) and cortisol to insulin-induced hypoglycemia in 20 healthy controls and 18 inpatients with MD [12 dexamethasone suppressors (S) and 5 dexamethasone nonsuppressors (NS)]. After the administration of 0.15 U/kg of regular insulin, both controls and patients with MD showed an increase in plasma ACTH and cortisol levels. Controls had a significantly higher ACTH peak (p less than 0.01) and ACTH increment (p less than 0.01) than MD patients. There were no statistically significant differences between patients who were S and NS. Although baseline plasma cortisol levels were significantly higher in MD patients, there were no significant differences in the peak cortisol or increment in plasma cortisol after hypoglycemia between patients with MD and controls or between patients who were S and those who were NS. These findings suggest that a defect exists in the regulation of the HPA axis at the pituitary level in MD and that this defect is not necessarily reflected in the dexamethasone suppression status of the patient.
下丘脑-垂体-肾上腺（HPA）轴功能障碍表现为地塞米松后皮质醇分泌未能被抑制，在约50%的重度抑郁症（MD）患者中可发现。在本研究中，我们检测了20名健康对照者和18名MD住院患者[12名地塞米松抑制者（S）和5名地塞米松非抑制者（NS）]对胰岛素诱导的低血糖时促肾上腺皮质激素（ACTH）和皮质醇的反应。给予0.15 U/kg的正规胰岛素后，对照者和MD患者的血浆ACTH和皮质醇水平均升高。对照者的ACTH峰值（p<0.01）和ACTH增加值（p<0.01）显著高于MD患者。S组和NS组患者之间无统计学显著差异。尽管MD患者的基线血浆皮质醇水平显著更高，但MD患者与对照者之间或S组与NS组患者之间，低血糖后皮质醇峰值或血浆皮质醇增加值并无显著差异。这些发现提示，MD患者垂体水平的HPA轴调节存在缺陷，且该缺陷不一定反映在患者的地塞米松抑制状态上。
