title: HPA axis dysregulation in men with hypersexual disorder.
abstract: Hypersexual disorder integrating pathophysiological aspects such as sexual desire deregulation, sexual addiction, impulsivity and compulsivity was suggested as a diagnosis for the DSM-5. However, little is known about the neurobiology behind this disorder. A dysregulation of the hypothalamic pituitary adrenal (HPA) axis has been shown in psychiatric disorders but has not been investigated in hypersexual disorder. The aim of this study was to investigate the function of the HPA axis in hypersexual disorder. The study includes 67 male patients with hypersexual disorder and 39 healthy male volunteers. Basal morning plasma levels of cortisol and ACTH were assessed and low dose (0.5mg) dexamethasone suppression test was performed with cortisol and ACTH measured post dexamethasone administration. Non-suppression status was defined with DST-cortisol levels ≥ 138 nmol/l. The Sexual Compulsive scale (SCS), Hypersexual disorder current assessment scale (HD:CAS), Montgomery-Åsberg Depression Scale-self rating (MADRS-S) and Childhood trauma questionnaire (CTQ), were used for assessing hypersexual behavior, depression severity and early life adversity. Patients with hypersexual disorder were significantly more often DST non-suppressors and had significantly higher DST-ACTH levels compared to healthy volunteers. The patients reported significantly more childhood trauma and depression symptoms compared to healthy volunteers. CTQ scores showed a significant negative correlation with DST-ACTH whereas SCS and HD:CAS scores showed a negative correlation with baseline cortisol in patients. The diagnosis of hypersexual disorder was significantly associated DST non-suppression and higher plasma DST-ACTH even when adjusted for childhood trauma. The results suggest HPA axis dysregulation in male patients with hypersexual disorder.
authors.affiliation: Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden. Electronic address: andreas.chatzittofis@ki.se.
authors.forename: Andreas
authors.initials: A
authors.lastname: Chatzittofis
authors.affiliation: Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Arver
authors.affiliation: Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Öberg
authors.affiliation: Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hallberg
authors.affiliation: Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Nordström
authors.affiliation: Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden; Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
authors.forename: Jussi
authors.initials: J
authors.lastname: Jokinen
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D016739:Behavior, Addictive / Q000097:blood / Q000503:physiopathology*; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D003907:Dexamethasone / Q000008:administration & dosage; D003940:Diagnostic Techniques, Endocrine; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology*; D020018:Sexual Dysfunctions, Psychological / Q000097:blood / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: ACTH; Cortisol; Dexamethasone suppression test; HPA axis; Hypersexual disorder childhood trauma