The combined dexamethasone-suppression/CRH-stimulation test in alcoholics during and after acute withdrawal.
BACKGROUND
Chronic alcoholism is often accompanied by disturbances of the hypothalamic-pituitary-adrenal (HPA) system. Patients with alcoholism frequently show nonsuppression in the dexamethasone (Dex) suppression test and also a blunted increase of adrenocorticotropin (ACTH) after injection of corticotropin-releasing hormone (hCRH). However, the underlying mechanisms have not been fully elucidated. The combined Dex/CRH test (pretreatment with 1.5 mg dexamethasone at 2300 hr, injection of 100 microg hCRH at 1500 hr the next day) has been established as a more sensitive tool to investigate HPA system regulation in depressed patients.


METHODS
We studied the effect of the combined Dex/CRH test in 19 alcoholic inpatients (9 male, 10 female) during and after withdrawal along with 19 healthy controls.


RESULTS
Compared to normal controls, patients showed a severely dysregulated HPA system during withdrawal, with significantly elevated cortisol and ACTH response to hCRH after pretreatment with dexamethasone. After completed withdrawal, cortisol levels after injection of hCRH were almost normalized while ACTH values were partially lower in patients, compared to controls.


CONCLUSIONS
We conclude that the HPA system is severely disturbed during alcohol withdrawal, possibly reflecting an exaggerated release of hypothalamic corticotropin and vasopressin.
Hundt
W
W
Max Planck Institute of Psychiatry, Kraepelinstrasse 10, 80804 München, Germany.
Zimmermann
U
U
Pöttig
M
M
Spring
K
K
Holsboer
F
F
D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000187:drug effects*; D000328:Adult; D000437:Alcoholism / Q000097:blood*; D000893:Anti-Inflammatory Agents; D002492:Central Nervous System Depressants / Q000009:adverse effects; D003346:Corticotropin-Releasing Hormone; D003907:Dexamethasone; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism; D013375:Substance Withdrawal Syndrome / Q000097:blood*
D000893:Anti-Inflammatory Agents; D002492:Central Nervous System Depressants; D000431:Ethanol; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone