title: Increased left ventricular mass in hypercortisolemic depressed patients: a hypothesis based on a case series.
abstract: BACKGROUND
  Hypercortisolemia in depressed patients is known to be related to changes in body composition, especially increased ectopic fat and lowered bone mineral density. Both hypercortisolemia in patients with Cushing's disease and depression in patients undergoing treatment with hemodialysis have been shown to be associated with increased left ventricular mass.
  
  
  OBJECTIVE
  Increased activity of the hypothalamus-pituitary-adrenal (HPA) system in depressed patients is related to high left ventricular mass.
  
  
  METHODS
  To corroborate our hypothesis, we measured left ventricular mass in 5 depressed patients with clear evidence for HPA system activation (nonsuppression in dexamethasone suppression test [DST]; increased 24 h cortisol excretion) and 27 healthy controls. We found increased left ventricular mass in hypercortisolemic depressed patients compared to healthy controls (343±97 vs. 176±57 gr; p=0.007).
  
  
  CONCLUSIONS
  Depression is known to be related to an increased risk of cardial morbidity and mortality, although the risk architecture is not completely understood. We hypothesize that hypercortisolemic depression is associated with increased left ventricular mass, which is known to be a strong predictor for cardial mortality. Thus, a potential effect of activated stress-responsive systems on heart morphology may contribute to depressed patients' increased cardiovascular risk.
authors.affiliation: Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, 68159 Mannheim, Germany. Electronic address: maria.gilles@zi-mannheim.de.
authors.forename: Maria
authors.initials: M
authors.lastname: Gilles
authors.affiliation: Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, 68159 Mannheim, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Scharnholz
authors.affiliation: Dept. of Neurology, University Medical Center Mannheim, 68167 Mannheim, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Marzina
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Kommer
authors.affiliation: Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, 35390 Gießen, Germany.
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Wudy
authors.affiliation: Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, 35390 Gießen, Germany.
authors.forename: Michaela F
authors.initials: MF
authors.lastname: Hartmann
authors.affiliation: Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, 68159 Mannheim, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Lederbogen
authors.affiliation: Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, 68159 Mannheim, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meyer-Lindenberg
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Michaely
authors.affiliation: Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, 68159 Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Deuschle
mesh_terms: D000328:Adult; D001823:Body Composition; D015519:Bone Density; D016022:Case-Control Studies; D003863:Depression / Q000150:complications / Q000503:physiopathology*; D003907:Dexamethasone / Q000737:chemistry; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000150:complications
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone