Serial CSF corticotropin-releasing hormone levels and adrenocortical activity in combat veterans with posttraumatic stress disorder.
OBJECTIVE
The authors sought to carefully test, by using a technique of continuous CSF sampling, the hypothesis that basal elevations in CSF corticotropin-releasing hormone (CRH) concentrations exist in patients with posttraumatic stress disorder (PTSD). They also sought to assess the relationship among PTSD symptoms, adrenocortical activity, and CSF CRH levels.


METHODS
CSF was withdrawn by means of a flexible, indwelling subarachnoid catheter over a 6-hour period, and hourly CSF concentrations of CRH were determined for 11 well-characterized combat veterans with PTSD and 12 matched normal volunteers. Twenty-four-hour urinary-free cortisol excretion was also determined. PTSD and depressive symptoms were correlated with the neuroendocrine data.


RESULTS
Mean CSF CRH levels were significantly greater in PTSD patients than in normal subjects (55.2 [SD = 16.4] versus 42.3 pg/ml [SD = 15.6]). No correlation was found between CSF CRH concentrations and PTSD symptoms. While there was no significant difference between groups in 24-hour urinary-free cortisol excretion, the correlation between 24-hour urinary-free cortisol excretion and PTSD symptoms was negative and significant.


CONCLUSIONS
By using a serial CSF sampling technique, the authors found high basal CSF CRH concentrations and normal 24-hour urinary-free cortisol excretion in combat veterans with PTSD, a combination that appears to be unique among psychiatric conditions studied to date.
Baker
D G
DG
Psychiatry Service, Cincinnati VA Medical Center, OH, USA. Dewleen.Baker@uc.edu
West
S A
SA
Nicholson
W E
WE
Ekhator
N N
NN
Kasckow
J W
JW
Hill
K K
KK
Bruce
A B
AB
Orth
D N
DN
Geracioti
T D
TD
D000302:Adrenal Cortex / Q000378:metabolism*; D000328:Adult; D000704:Analysis of Variance; D002408:Catheters, Indwelling; D002555:Cerebrospinal Fluid / Q000737:chemistry; D002940:Circadian Rhythm / Q000502:physiology; D003130:Combat Disorders / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D003346:Corticotropin-Releasing Hormone / Q000134:cerebrospinal fluid*; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008297:Male; D008875:Middle Aged; D013129:Spinal Puncture / Q000379:methods; D013346:Subarachnoid Space
D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone