Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder.
BACKGROUND
Hypothalamic-pituitary-adrenal (HPA) axis function, as variously measured by the responses to the combined dexamethasone/corticotrophin-releasing hormone (dex/CRH) test, the dexamethasone suppression test (DST) and basal cortisol levels, has been reported to be abnormal in bipolar disorder.


OBJECTIVE
To test the hypothesis that HPA axis dysfunction persists in patients in remission from bipolar disorder.


METHODS
Salivary cortisol levels and the plasma cortisol response to the DST and dex/CRH test were examined in 53 patients with bipolar disorder, 27 of whom fulfilled stringent criteria for remission, and in 28 healthy controls. Serum dexamethasone levels were measured.


RESULTS
Patients with bipolar disorder demonstrated an enhanced cortisol response to the dex/CRH test compared with controls (P=0.001). This response did not differ significantly between remitted and non-remitted patients. These findings were present after the potentially confounding effects of dexamethasone levels were accounted for.


CONCLUSIONS
The dex/CRH test is abnormal in both remitted and non-remitted patients with bipolar disorder. This measure of HPA axis dysfunction is a potential trait marker in bipolar disorder and thus possibly indicative of the core pathophysiological process in this illness.
Watson
Stuart
S
The Stanley Research Centre, University of Newcastle upon Tyne, The Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Gallagher
Peter
P
Ritchie
James C
JC
Ferrier
I Nicol
IN
Young
Allan H
AH
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology*; D002220:Carbamazepine / Q000627:therapeutic use; D003346:Corticotropin-Releasing Hormone; D003430:Cross-Sectional Studies; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests / Q000379:methods; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012463:Saliva / Q000737:chemistry
D000928:Antidepressive Agents; D018692:Antimanic Agents; D002220:Carbamazepine; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone