Carson S W, Halbreich U, Yeh C M, Goldstein S
Department of Psychiatry, State University of New York, Buffalo 14215.
Biol Psychiatry. 1988 May;24(1):56-62. doi: 10.1016/0006-3223(88)90121-7.
Some abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis in patients with panic disorders were recently reported. The possibility that the disposition of dexamethasone, which has been reported to influence the Dexamethasone Suppression Test (DST), might be altered in this subgroup of patients has not, as yet, been reported. We report that 4:00 PM dexamethasone plasma concentrations following a 1-mg oral DST were significantly (p less than 0.01) lower in 23 patients with panic disorders (0.49 +/- 0.44 ng/ml) compared to 52 normal control subjects (1.09 +/- 0.64 ng/ml). This is in addition to the significantly higher (p less than 0.05) 4:00 PM postdexamethasone cortisol values per nanogram per milliliter of dexamethasone in the panic disorder patients compared to normal controls (17.7 +/- 29.6 versus 5.0 +/- 11.2 micrograms/dl). The mean percent suppression of cortisol from baseline in panic disorder was normal despite one-half the dexamethasone concentrations in these subjects. The cortisol suppression versus dexamethasone concentration curve was also shifted lower (greater fraction of cortisol suppression) and to the left (toward lower dexamethasone concentrations). These results further suggest that the HPA system is indeed altered in panic disorders, but in a manner that is not readily apparent from the DST alone.
近期有报道称，惊恐障碍患者的下丘脑 - 垂体 - 肾上腺（HPA）轴存在一些异常情况。据报道，地塞米松的处置会影响地塞米松抑制试验（DST），而在这一亚组患者中，其处置情况是否发生改变，目前尚未见报道。我们报告称，在进行1毫克口服DST后，23例惊恐障碍患者下午4点的地塞米松血浆浓度（0.49±0.44纳克/毫升）显著低于（p＜0.01）52名正常对照者（1.09±0.64纳克/毫升）。此外，与正常对照者相比，惊恐障碍患者每纳克/毫升地塞米松下午4点的地塞米松后皮质醇值显著更高（p＜0.05）（分别为17.7±29.6与5.0±11.2微克/分升）。尽管这些患者的地塞米松浓度仅为正常对照者的一半，但惊恐障碍患者皮质醇从基线的平均抑制百分比仍属正常。皮质醇抑制与地塞米松浓度曲线也向下移动（皮质醇抑制比例更高）且向左移动（朝着更低的地塞米松浓度方向）。这些结果进一步表明，惊恐障碍患者的HPA系统确实发生了改变，但其方式并非仅通过DST就能轻易看出。
