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Dissociation between ACTH and cortisol response in DEX-CRH test in patients with panic disorder.
Psychoneuroendocrinology. 2012 Aug; 37(8):1199-208.P

Abstract

BACKGROUND

Panic disorder (PD) has been associated with the altered circadian rhythm of the hypothalamic-pituitary-adrenocortical (HPA) axis. The findings regarding the stress-specific functioning of the HPA-system are inconsistent. It is also unclear whether the HPA-system response after the Corticotropin-Releasing-Hormone (CRH) challenge becomes altered.

METHODS

For this study, the dexamethasone-corticotropin-releasing-hormone (DEX-CRH) test was implemented to assess the HPA-axis reactivity indicated by the plasma adreno-corticotropin-hormone (ACTH) and the cortisol release. The sample included 32 patients diagnosed with PD in a Structured Clinical Interview (SCID). Fourteen male and eighteen female patients, [mean age = 33.50 years, SD = 12.76] were matched with 32 healthy controls by age and gender. Moreover, a sample of patients with unipolar depression (n = 21, ten females) was examined as a clinical control group.

RESULTS

In healthy controls as well as in patients with PD and patients with unipolar depression, the ACTH and the cortisol response increased significantly due to the CRH injection after dexamethasone pre-treatment. There were differences between the healthy controls and the patients with PD in the plasma cortisol response pattern, however, not in the ACTH. The patients with PD showed a decreased CRH-induced plasma cortisol response. A median-split gave evidence that patients suffering from PD longer than two years showed a remarkably higher HPA-axis reactivity under CRH-injection than patients suffering from PD two years or less.

CONCLUSION

These findings provide strong evidence that patients with PD show some dissociation between ACTH and cortisol response under the DEX-CRH test with strong indicators that the length of the duration of the psychopathology is a risk factor for an increased reactivity of the HPA-axis in patients with PD.

Authors+Show Affiliations

Institute of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany. katja.petrowski@mailbox.tu-dresden.deNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22277728

Citation

Petrowski, Katja, et al. "Dissociation Between ACTH and Cortisol Response in DEX-CRH Test in Patients With Panic Disorder." Psychoneuroendocrinology, vol. 37, no. 8, 2012, pp. 1199-208.
Petrowski K, Wintermann GB, Kirschbaum C, et al. Dissociation between ACTH and cortisol response in DEX-CRH test in patients with panic disorder. Psychoneuroendocrinology. 2012;37(8):1199-208.
Petrowski, K., Wintermann, G. B., Kirschbaum, C., & Bornstein, S. R. (2012). Dissociation between ACTH and cortisol response in DEX-CRH test in patients with panic disorder. Psychoneuroendocrinology, 37(8), 1199-208. https://doi.org/10.1016/j.psyneuen.2011.12.013
Petrowski K, et al. Dissociation Between ACTH and Cortisol Response in DEX-CRH Test in Patients With Panic Disorder. Psychoneuroendocrinology. 2012;37(8):1199-208. PubMed PMID: 22277728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dissociation between ACTH and cortisol response in DEX-CRH test in patients with panic disorder. AU - Petrowski,Katja, AU - Wintermann,Gloria-Beatrice, AU - Kirschbaum,Clemens, AU - Bornstein,Stefan R, Y1 - 2012/01/23/ PY - 2011/09/16/received PY - 2011/12/14/revised PY - 2011/12/14/accepted PY - 2012/1/27/entrez PY - 2012/1/27/pubmed PY - 2012/11/6/medline SP - 1199 EP - 208 JF - Psychoneuroendocrinology JO - Psychoneuroendocrinology VL - 37 IS - 8 N2 - BACKGROUND: Panic disorder (PD) has been associated with the altered circadian rhythm of the hypothalamic-pituitary-adrenocortical (HPA) axis. The findings regarding the stress-specific functioning of the HPA-system are inconsistent. It is also unclear whether the HPA-system response after the Corticotropin-Releasing-Hormone (CRH) challenge becomes altered. METHODS: For this study, the dexamethasone-corticotropin-releasing-hormone (DEX-CRH) test was implemented to assess the HPA-axis reactivity indicated by the plasma adreno-corticotropin-hormone (ACTH) and the cortisol release. The sample included 32 patients diagnosed with PD in a Structured Clinical Interview (SCID). Fourteen male and eighteen female patients, [mean age = 33.50 years, SD = 12.76] were matched with 32 healthy controls by age and gender. Moreover, a sample of patients with unipolar depression (n = 21, ten females) was examined as a clinical control group. RESULTS: In healthy controls as well as in patients with PD and patients with unipolar depression, the ACTH and the cortisol response increased significantly due to the CRH injection after dexamethasone pre-treatment. There were differences between the healthy controls and the patients with PD in the plasma cortisol response pattern, however, not in the ACTH. The patients with PD showed a decreased CRH-induced plasma cortisol response. A median-split gave evidence that patients suffering from PD longer than two years showed a remarkably higher HPA-axis reactivity under CRH-injection than patients suffering from PD two years or less. CONCLUSION: These findings provide strong evidence that patients with PD show some dissociation between ACTH and cortisol response under the DEX-CRH test with strong indicators that the length of the duration of the psychopathology is a risk factor for an increased reactivity of the HPA-axis in patients with PD. SN - 1873-3360 UR - https://www.unboundmedicine.com/medline/citation/22277728/Dissociation_between_ACTH_and_cortisol_response_in_DEX_CRH_test_in_patients_with_panic_disorder_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-4530(11)00368-4 DB - PRIME DP - Unbound Medicine ER -