title: [Contributions of cortisol suppression tests to understanding of psychiatric disorders: a narrative review of literature].
abstract: Activity of the hypothalamic-pituitary-adrenal axis had been studied for the past half century, when some researchers noted that some patients with Cushing's syndrome and severe mood disorders had high baseline cortisol levels, which resulted in an inhibited response in the 1mg dexamethasone suppression test. Altered dexamethasone suppression test results were subsequently found in many psychiatric diseases, including anorexia nervosa, obsessive-compulsive disorder, degenerative dementia, bipolar disorders, and schizophrenia. The relationship between high baseline cortisol levels and stress has also been studied. Some researches on the genesis of borderline personality disorder focused on traumatic childhood backgrounds. Other investigations aimed at elucidating the relationship between traumatic backgrounds and some psychiatric disorders noted that patients with post-traumatic stress disorder and borderline personality disorder showed an enhanced cortisol suppression with low cortisol doses (0.5 mg). Recent studies showed that use of an ultra-low dose of cortisol during the dexamethasone suppression test may be helpful for detecting disorders with hyperactivity of the hypothalamic-pituitary-adrenal axis. Recent advances in neuroimaging support the existence of hyperactivity of the hypothalamic-pituitary-adrenal axis in patients with borderline personality disorder, relating a decreased pituitary gland volume to major traumatic backgrounds and suicidal attempts. The purpose of this paper is to make a narrative review of research using dexamethasone suppression test in psychiatric disorders, in order to ascertain its value as a supplemental diagnostic test or as a prognostic marker.
authors.affiliation: Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, España. doctortajimapozo@gmail.com
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tajima-Pozo
authors.forename: Ana
authors.initials: A
authors.lastname: Montes-Montero
authors.forename: Itziar
authors.initials: I
authors.lastname: Güemes
authors.forename: Sara
authors.initials: S
authors.lastname: González-Vives
authors.forename: Marina
authors.initials: M
authors.lastname: Díaz-Marsá
authors.forename: José Luis
authors.initials: JL
authors.lastname: Carrasco
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000503:physiopathology; D002940:Circadian Rhythm; D003346:Corticotropin-Releasing Hormone; D003480:Cushing Syndrome / Q000175:diagnosis / Q000503:physiopathology; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology; D003907:Dexamethasone / Q000008:administration & dosage / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D025461:Feedback, Physiological / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism* / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology* / Q000652:urine; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011379:Prognosis; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012636:Secretory Rate; D013315:Stress, Psychological / Q000175:diagnosis / Q000503:physiopathology / Q000652:urine
chemical_list: D011619:Psychotropic Drugs; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
keywords: Borderline personality disorder; Cortisol; Depresión; Depression; Dexametasona; Dexamethasone; Dexamethasone suppression test; Eje hipotálamo-hipofisario-adrenal; Estrés; Hypothalamic-pituitary-adrenal axis; Stress; Test supresión dexametosona; Trastorno límite personalidad