title: Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder.
abstract: BACKGROUND
  Neuroendocrine studies have shown profound alterations in HPA-axis regulation in posttraumatic stress disorder (PTSD). Based on baseline assessments and the response to dexamethasone, a hypothalamic overdrive with enhanced glucocorticoid feedback inhibition has been suggested. The dexamethasone-corticotrophin releasing hormone (DEX-CRH) test has shown to be a more sensitive test to assess HPA-axis dysregulation in major depression and therefore may provide a useful test tool to probe HPA-axis regulation in PTSD.
  
  
  METHODS
  To evaluate the effect of PTSD on HPA-axis regulation, we compared the response to a DEX-CRH test between male veterans with PTSD (n=26) and male veterans, who had been exposed to similar traumatic events during their deployment, without PTSD (n=23). Patients and controls were matched on age, year and region of deployment. Additionally, we compared the response of PTSD patients with (n=13) and without co-morbid major depressive disorder (MDD) (n=13).
  
  
  RESULTS
  No significant differences were observed in ACTH and cortisol response to the DEX-CRH test between patients and controls. PTSD patients with co-morbid MDD showed a significantly lower ACTH response compared to patients without co-morbid MDD. The response to the DEX-CRH test did not correlate with PTSD or depressive symptoms.
  
  
  CONCLUSIONS
  The DEX-CRH test did not reveal HPA-axis abnormalities in PTSD patients as compared to trauma controls. PTSD patients with a co-morbid MDD showed an attenuated ACTH response compared to PTSD patients without co-morbid MDD, suggesting the presence of subgroups with different HPA-axis regulation within the PTSD group. Altered sensitivity of the CRH receptors at the pituitary or differences in AVP secretion might explain these differences in response.
authors.affiliation: Department of Military Psychiatry, Central Military Hospital, Utrecht, The Netherlands. c.de.kloet@altrecht.nl
authors.forename: Carien
authors.initials: C
authors.lastname: de Kloet
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
authors.forename: Eef
authors.initials: E
authors.lastname: Lentjes
authors.forename: Elbert
authors.initials: E
authors.lastname: Geuze
authors.forename: Johannes
authors.initials: J
authors.lastname: van Pelt
authors.forename: Remy
authors.initials: R
authors.lastname: Manuel
authors.forename: Cobi
authors.initials: C
authors.lastname: Heijnen
authors.forename: Herman
authors.initials: H
authors.lastname: Westenberg
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D003346:Corticotropin-Releasing Hormone; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003907:Dexamethasone; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D011569:Psychiatric Status Rating Scales; D011965:Receptors, Glucocorticoid / Q000187:drug effects; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D014728:Veterans
chemical_list: D011965:Receptors, Glucocorticoid; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone