The relationship of endogenous cortisol to psychiatric disorder: a review.
OBJECTIVE
To focus on hypothalamic-pituitary-adrenal (HPA) axis activity, especially endogenous hypercortisolemia, to study its role in the maintenance of psychiatric illness, and to entertain the probability that the elderly are vulnerable.


METHODS
Case presentation, clinical and research literature review, and theoretical discussion.


RESULTS
Clinical and research evidence overwhelmingly suggest that hypercortisolemia is toxic to the hippocampus. Some research supports the position that it can be a treatable perpetuating factor in a subset of affective disorders and psychoses. Pharmacological treatments to correct hypercortisolemia have been used by endocrinologists. Hypercortisolemic treatment-resistant and nontreatment-resistant psychoses and affective disorders have been successfully treated by a small number of researchers who remain interested in this subject. Data pertaining to geriatric psychoses may be germane but are sparse.


CONCLUSIONS
It behooves us to research diagnostic methods pertaining to psychoses and affective disorders associated with hypercortisolemic states. Very little research is available, but we must be alert to the possibility that the elderly are more susceptible to cortisol endotoxicosis than the younger adult population. Without accurate diagnosis, we cannot take advantage of existing antiglucocorticoid strategies.
Kiraly
S J
SJ
St Vincent's Hospital, Vancouver, British Columbia.
Ancill
R J
RJ
Dimitrova
G
G
D000308:Adrenocortical Hyperfunction / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology
D006854:Hydrocortisone