Metyrapone tests in patients with panic disorder.
BACKGROUND
Studies of hypothalamic secretion of corticotropin-releasing hormone (CRH) in patients with panic disorder in the nonpanic state (using CRH tests) are contradictory. No data about the hypothalamic-pituitary response to metyrapone are available.


METHODS
Study participants included 14 patients with panic disorder (DSM-IV criteria) and 14 healthy control subjects who underwent a standard overnight metyrapone test and a combined metyrapone/low-dose dexamethasone test.


RESULTS
Significant treatment effects of metyrapone and combined metyrapone/dexamethasone were found on plasma corticotropin, cortisol, and 11-deoxycortisol, but no differences between patients and control subjects emerged. Considering visual analogue scale ratings of anxiety, tension, restlessness, and Beck Depression Inventory scores as covariates, no group effects were detected.


CONCLUSIONS
Standard overnight metyrapone tests do not support a hypersecretion of hypothalamic CRH in panic disorder. Furthermore, no evidence for increased glucocorticoid negative feedback in panic was found. Hypothalamic CRH secretion in the nonpanic state needs further research.
Kellner
Michael
M
Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. kellner@uke.uni-hamburg.de
Schick
Mildred
M
Yassouridis
Alexander
A
Struttmann
Tobias
T
Wiedemann
Klaus
K
Alm
Barbara
B
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000963:Antimetabolites / Q000627:therapeutic use; D016022:Case-Control Studies; D003350:Cortodoxone / Q000097:blood; D003907:Dexamethasone / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008797:Metyrapone / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement; D016584:Panic Disorder / Q000097:blood / Q000188:drug therapy*; D016037:Single-Blind Method
D000963:Antimetabolites; D004338:Drug Combinations; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003350:Cortodoxone; D008797:Metyrapone