Abstract
BACKGROUND: Neuroendocrine studies have shown profound alterations in HPA-axis regulation in posttraumatic stress disorder (PTSD). Based on baseline assessments and the response to dexamethasone, a hypothalamic overdrive with enhanced glucocorticoid feedback inhibition has been suggested. The dexamethasone-corticotrophin releasing hormone (DEX-CRH) test has shown to be a more sensitive test to assess HPA-axis dysregulation in major depression and therefore may provide a useful test tool to probe HPA-axis regulation in PTSD.
METHODS: To evaluate the effect of PTSD on HPA-axis regulation, we compared the response to a DEX-CRH test between male veterans with PTSD (n=26) and male veterans, who had been exposed to similar traumatic events during their deployment, without PTSD (n=23). Patients and controls were matched on age, year and region of deployment. Additionally, we compared the response of PTSD patients with (n=13) and without co-morbid major depressive disorder (MDD) (n=13).
RESULTS: No significant differences were observed in ACTH and cortisol response to the DEX-CRH test between patients and controls. PTSD patients with co-morbid MDD showed a significantly lower ACTH response compared to patients without co-morbid MDD. The response to the DEX-CRH test did not correlate with PTSD or depressive symptoms.
CONCLUSION: The DEX-CRH test did not reveal HPA-axis abnormalities in PTSD patients as compared to trauma controls. PTSD patients with a co-morbid MDD showed an attenuated ACTH response compared to PTSD patients without co-morbid MDD, suggesting the presence of subgroups with different HPA-axis regulation within the PTSD group. Altered sensitivity of the CRH receptors at the pituitary or differences in AVP secretion might explain these differences in response.
Original language | English |
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Pages (from-to) | 313-320 |
Number of pages | 8 |
Journal | Psychoneuroendocrinology |
Volume | 33 |
Issue number | 3 |
DOIs | |
Publication status | Published - Apr 2008 |
Keywords
- Adrenocorticotropic Hormone/blood
- Adult
- Corticotropin-Releasing Hormone
- Data Interpretation, Statistical
- Depressive Disorder/complications
- Dexamethasone
- Humans
- Hydrocortisone/blood
- Hypothalamo-Hypophyseal System/physiopathology
- Male
- Psychiatric Status Rating Scales
- Receptors, Glucocorticoid/drug effects
- Stress Disorders, Post-Traumatic/complications
- Veterans