A combined dexamethasone/corticotropin-releasing hormone test in patients with chronic PTSD--first preliminary results.
BACKGROUND
Reports about alterations of hypothalamic-pituitary-adrenocortical (HPA) function in patients with chronic posttraumatic stress disorder (PTSD) are inconsistent and controversial. More refined laboratory tests and subgrouping of PTSD patients might help to decrease variance of findings.


METHODS
14 subjects with chronic PTSD and 14 healthy controls were examined between 13:00 and 17:00 using a modified combined dexamethasone/CRH test (0.5 mg dexamethasone at 23:00, 100 microg CRH at 15:00). Plasma adenocorticotropic hormone (ACTH), cortisol and blood pressure were measured every 15 min from 14:45 until 17:00.


RESULTS
No significant differences between patients and controls were found in the analyses of ACTH and cortisol levels, but a significantly elevated systolic and diastolic blood pressure in PTSD. Severity of depressive symptoms had no influence. However, explorative analyses showed that patients with a history of childhood traumatization had significantly higher post-dexamethasone-ACTH levels and a significantly lower diastolic blood pressure in comparison to patients without early trauma.


CONCLUSIONS
In this first pilot study in a typical clinical sample of patients with chronic PTSD we found effects of severe adverse events in childhood on HPA axis regulation. Maybe, childhood traumatization could influence HPA axis findings in PTSD. Further research is needed, especially dose-response studies with different doses of dexamethasone in dexamethasone/CRH tests in PTSD.
Muhtz
Christoph
C
Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. cmuhtz@uke.uni-hamburg.de
Wester
Monika
M
Yassouridis
Alexander
A
Wiedemann
Klaus
K
Kellner
Michael
M
D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology; D015897:Comorbidity; D035061:Control Groups; D003346:Corticotropin-Releasing Hormone; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology
D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone