title: Relationship between hypothalamic-pituitary-adrenal axis dysregulation and insulin resistance in elderly patients with depression.
abstract: Cortisol dysregulation has been proposed to be involved in depression. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation associated with major depressive disorder (MDD) was previously reported to be higher in the elderly. Furthermore, insulin resistance and the prevalence of type 2 diabetes are known to increase with aging. The aim of the present study was to determine whether a relationship existed between plasma cortisol levels following the dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test and insulin resistance evaluated by the homeostasis model assessment of insulin resistance (HOMA-R) in elderly MDD subjects. Fifteen unmedicated MDD inpatients and 17 age- and sex-matched healthy controls participated in this study. After overnight fasting, blood samples were collected to measure plasma glucose and insulin concentrations, estimate HOMA-R, and perform the DEX/CRH test to evaluate HPA axis function. The value of the area under the time curve of plasma cortisol concentrations (CortAUC) and peak cortisol values (Cortpeak) following the administration of DEX/CRH both correlated with HOMA-R in MDD group. In contrast, neither CortAUC nor Cortpeak correlated with HOMA-R in controls. This is the first study to directly demonstrate the relationship between HPA axis dysregulation assessed with the DEX/CRH test and the index of insulin resistance estimated as HOMA-R in elderly MDD patients.
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan. Electronic address: kyinyonago@yahoo.co.jp.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Division of Psychiatry, Kurayoshi Hospital, 43 Yamane, Kurayoshi, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mitani
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
authors.forename: Shenghong
authors.initials: S
authors.lastname: Pu
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Yamanashi
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumura
authors.affiliation: National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nakagome
authors.affiliation: Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaneko
mesh_terms: D000368:Aged; D000375:Aging / Q000097:blood* / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000097:blood* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D007328:Insulin; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
keywords: Depression; Dexamethasone (DEX/CRH) test; Diabetes; Homeostasis model assessment of insulin resistance (HOMA-R); Hypothalamic–Pituitary–Adrenal (HPA) axis; Insulin resistance