title: The dex/CRH test--is it better than the DST?
abstract: The dexamethasone suppression test (DST), frequently abnormal in mood disorder patients, is considered to measure glucocorticoid receptor-mediated negative feedback. We examined the hypothesis that the, apparently more sensitive, dexamethasone/corticotrophin-releasing-hormone (dex/CRH) test unveils subtle hypothalamic-pituitary-adrenal axis disturbance not detected by the DST in 82 patients with mood disorders and 28 controls. There was a close correlation between the cortisol responses on the two tests (r(s)=0.73, p<0.0005). However, ROC analysis revealed that the dex/CRH test had better diagnostic performance than the DST (p=0.031). The sensitivity of delta cortisol (from the dex/CRH) was 61.9% and the specificity 71.4%. The sensitivity of 1500 h cortisol (the DST) was 66.6% and the specificity was 47.6%. This suggests that the two tests measure common pathology but that the dex/CRH test has better diagnostic utility.
authors.affiliation: School of Neurology, Neurobiology and Psychiatry, The Stanley Research Centre, University of Newcastle upon Tyne, Leazes Wing (Psychiatry), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. stuart.watson@ncl.ac.uk
authors.forename: Stuart
authors.initials: S
authors.lastname: Watson
authors.forename: Peter
authors.initials: P
authors.lastname: Gallagher
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Smith
authors.forename: I Nicol
authors.initials: IN
authors.lastname: Ferrier
authors.forename: Allan H
authors.initials: AH
authors.lastname: Young
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D003346:Corticotropin-Releasing Hormone; D003864:Depression, Chemical; D003866:Depressive Disorder / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D003907:Dexamethasone; D025461:Feedback, Physiological; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology / Q000503:physiopathology; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone