Postnatal gonadal steroid effects on human behavior.

Gonadal steroid hormones, active during fetal life, continue after the birth of a fetus to influence the central nervous system and affect behavior. The characteristically different circulating concentrations of male and female steroid hormones in men and women appear to be partial determinants of certain sexually dimorphic behaviors, interacting in a complex way with psychological and sociocultural factors as well as with other biological factors. This interaction is highlighted in research on testosterone and aggression in men, mood and the menstrual cycle in women, and pubertal sex role reversal in pseudohermaphrodites.

Corticosteroid responses to limbic stimulation in man: localization of stimulus sites.

Corticosteroids in human plasma and urine increase after amygdala stimulation, and plasma corticosteroids decrease after hippocampus stimulation. Five subjects underwent unilateral temporal lobectomy, and histopathologic localization of electrode sites was attempted. Localization was successful for six sites: three in basolateral amygdala and three in hippocampus.

Gonadotropin secretion during sleep in normal adult men.

Release of luteinizing hormone and follicle stimulating hormone during sleep in young adult men occurred in unrelated, random, arrhythmic peaks, with no consistency from night to night in the same subject. Release of luteinizing hormone was modestly but significantly larger (14 perecnt) during rapid-eye-movement sleep than it was in non-REM sleep, but release of follicle stimulating hormone was not clearly related to stages of sleep.

Dreaming sleep in man: changes in urine volume and osmolality.

Epochs of dreaming sleep, as measured by rapid eye movements, consistently correlated with biphasic change in urine volume and osmolality in catheterized human subjects. Marked decrease in volumne and increase in oslnolality were followed by a hypotonic diuresis.

Steroid hormones partition to distinct sites in a model membrane bilayer: direct demonstration by small-angle X-ray diffraction.

The classical, genomic mechanisms of steroid hormone action cannot account for their rapid cellular effects. Membrane-bound steroid receptors have been partially characterized, but many rapid steroid effects occur in the absence of steroid-protein binding. Although it has been proposed that these effects could be due to steroid-induced biophysical alterations of the cell membrane, only indirect supporting evidence for this hypothesis has been forthcoming. In the present study, the ability of cortisol and estradiol (E2), natural steroids of different lipophilicity, to induce alterations in a model membrane (lecithin) bilayer was examined directly by small-angle X-ray diffraction under physiologic-like conditions. Within minutes, both steroids partitioned to distinct sites in the membrane. With increasing membrane cholesterol content, cortisol was displaced toward the polar headgroup region of the phospholipid bilayer, whereas E2 was displaced in the opposite direction, toward the nonpolar hydrocarbon core. Membrane-based partition coefficients (Kp[mem]) for both steroids (>100:1) were highest at those cholesterol concentrations that displaced the steroids toward the headgroup region (high cholesterol for cortisol; low for E2). Both steroids, when located in the headgroup region, increased overall bilayer width by 3-4 A, a change that could modulate the structure and function of integral membrane proteins independent from steroid effects on the genome.

Pituitary-adrenal responses to cholinergic stimulation and acute mild stress are differentially elevated in male and female M(2) muscarinic receptor knockout mice.

Adrenocorticotrophic hormone (ACTH) and corticosterone responses to cholinergic stimulation are greater in male rats and mice than in females. To explore the role of M(2) muscarinic receptors in this sex difference, we administered the nonselective muscarinic agonist, oxotremorine, the acetylcholinesterase inhibitor, physostigmine, and saline (a mild stressor) to male and female M(2) receptor knockout (KO) and wild-type (WT) mice of the same genetic background. Because M(2) receptors function primarily as presynaptic autoreceptors, we hypothesized that their absence in M(2) KO mice would increase the sensitivity of hormone responses to cholinergic stimulation in these groups. Both male and female M(2) KO mice were significantly more responsive to the stress of saline injection than were their WT counterparts. Oxotremorine and physostigmine increased ACTH and corticosterone in all four groups, but to a significantly greater degree in KO males compared to WT males, KO females, and WT females. The increase in ACTH also was significantly greater in WT males compared to WT females. By contrast, the increase in corticosterone was significantly more in females compared to males, independent of genotype. Following pretreatment with the nonselective muscarinic antagonist, scopolamine, ACTH and corticosterone responses to oxotremorine and to saline in the M(2) KO mice were comparable with those of their WT counterparts. These findings suggest that the M(2) muscarinic receptor subtype influences male and female pituitary-adrenal responses following stimulation by both mild stress and cholinergic drugs. The M(2) receptor appears to regulate ACTH responses to cholinergic stimulation in males but not in females; however, other muscarinic receptors may be involved because corticosterone responses were higher in females compared to males. Because ACTH and corticosterone responses were greater in male and female M(2) KO mice, the M(2) receptor appears to dampen the stress response.

Decreased cortisol levels in adolescent girls with conduct disorder.

BACKGROUND: Female adolescent antisocial behavior is increasing, but little is known about the neuroendocrinologic aspects of this disorder. On the basis of reports of decreased cortisol levels in antisocial males, we investigated morning plasma cortisol levels in adolescent girls with conduct disorder (CD). METHODS: Three plasma samples for cortisol levels were taken every 20 minutes between 8 and 9 AM in 47 adolescent girls with CD (mean +/- SD age, 16.5 +/- 0.9 years) and 37 normal control girls (mean age, 16.0 +/- 0.8 years). All blood was drawn within 72 hours after the onset of menstrual flow. RESULTS: Girls with CD had significantly lower cortisol levels than girls in the normal control group at all 3 sampling times. This finding was not due to procedural factors, demographic characteristics, or the use of medications. The girls with CD who had no other psychiatric problems had lower cortisol levels than girls with other disorders or those in the normal control group. In the multiple regression analysis, having CD predicted 10% of the variance in cortisol levels. CONCLUSIONS: Morning plasma cortisol levels were significantly diminished in adolescent girls with CD. Decreased cortisol levels appear to be most strongly associated with antisocial girls who do not have other psychiatric disorders.

Neuroendocrine aspects of primary endogenous depression. I. Cortisol secretory dynamics in patients and matched controls.

To examine both predexamethasone and postdexamethasone cortisol measures in depression, we determined circadian serum cortisol patterns, cortisol responses to dexamethasone, and 24-hour urinary free cortisol excretion before and after dexamethasone administration in 40 patients with primary, definite endogenous depression diagnosed by Research Diagnostic Criteria and in 40 individually matched normal control subjects. Fifteen patients (38%) were dexamethasone nonsuppressors; they had significantly higher predexamethasone serum and urine cortisol measures than both their matched controls and the 25 suppressor patients. Both the predexamethasone and postdexamethasone cortisol measures were unimodally distributed across the patients and the controls. Circadian cortisol rhythms of similar magnitude occurred in both groups. The cortisol measures before and after dexamethasone administration were positively correlated to a similar degree in the patients and their controls, suggesting that predexamethasone hypothalamic-pituitary-adrenocortical hyperactivity and postdexamethasone cortisol nonsuppression are not independently determined in endogenous depression.

Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive-compulsive disorder and matched normal control subjects. Determination by high-resolution single-photon emission computed tomography.

We measured regional cerebral blood flow (rCBF) with the xenon 133 (133Xe) inhalation method and with regional cerebral uptake of technetium 99m d,l-hexamethyl propyleneamine oxime (99mTc-HMPAO) by single-photon emission computed tomography in 10 adult male patients with obsessive-compulsive disorder (OCD) and in 10 age-matched adult male normal controls. With the 133Xe method, there were no significant differences in cortical or basal ganglia blood flow between the patients with OCD and their matched controls. In the patients, there was a positive relationship between rCBF and the severity of both obsessive and compulsive symptoms (average r = .48). These rCBF findings were consistent with those of earlier reports of increased rCBF in patients with OCD who were undergoing imaginal flooding and who had exacerbation of symptoms following m-CPP administration. 99mTc-HMPAO is a lipophilic molecule that crosses the blood-brain barrier and is converted to a hydrophilic form that is trapped in the brain. The amount that is trapped is determined primarily by blood flow, but also by membrane permeability and kinetics of conversion of the 99mTc-HMPAO to the hydrophilic form. Compared with their matched controls, the patients with OCD had significantly increased 99mTc-HMPAO uptake in the high dorsal parietal cortex bilaterally, in the left posterofrontal cortex, and in the orbital frontal cortex bilaterally. Possible explanations include (1) increased rCBF that was not detected with 133Xe, (2) increased permeability of the blood-brain barrier and/or cell membranes, and (3) increased conversion and trapping of the lipophilic, injected form of 99mTc-HMPAO in these regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum haloperidol determinations in psychiatric patients. Comparison of methods and correlation with serum prolactin level.

Twenty-one serum samples from 11 schizophrenic patients receiving long-term haloperidol therapy were analyzed for haloperidol concentrations by two different radioimmunoassays (RIAs) and gas chromatography (GC). There was a good correspondence between the RIA and GC values over a wide range of drug concentrations. However, compared with the specific GC technique, both RIA methods overestimated haloperidol concentrations, reflecting differences in the specificities of the two RIA antibodies. One of the RIA methods had the requisite specificity for application to patients treated with long-term haloperidol therapy, although further methodological refinement will be required for its general clinical application. Haloperidol values determined by GC and RIA analyses correlated highly with prolactin concentrations in the same samples, suggesting that the usefulness of prolactin measurement as an "in vivo bioassay" for circulating levels of haloperidol should be further explored.

Neuroendocrine aspects of primary endogenous depression. XI. Serum melatonin measures in patients and matched control subjects.

To ascertain the extent of dysregulation of melatonin secretion in endogenous depression, we measured nocturnal and diurnal serum melatonin concentrations in 38 depressed patients (23 women and 15 men) who had primary, definite endogenous depression according to the Research Diagnostic Criteria and in 38 individually matched normal control subjects. Previous reports have suggested that such patients may have reduced nocturnal melatonin secretion, often in conjunction with increased hypothalamic-pituitary-adrenal cortical axis activity. This has been considered as a possible reflection of reduced noradrenergic activity in depression. Compared with their matched controls, the depressed patients showed a trend toward a significantly elevated average nocturnal melatonin concentration that was accounted for primarily by the 14 premenopausal women--the postmenopausal female and male depressive patients did not differ significantly from their respective controls. The average diurnal melatonin concentration also showed a trend toward being higher in both the female and male depressed patients. The melatonin measures were not consistently related to any of the previously reported hypothalamic-pituitary-adrenal cortical axis measures in these subjects. Our findings thus failed to confirm a "low melatonin syndrome" or an inverse relationship between nocturnal melatonin and nocturnal cortisol concentrations in depression. This discrepancy may be related to methodologic differences among studies; our data are in accord with those findings of the one other reported study in which normal controls were individually matched to patients on variables that were known to influence melatonin secretion. Most of the studies, including ours, have been cross-sectional.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuroendocrine aspects of primary endogenous depression. II. Serum dexamethasone concentrations and hypothalamic-pituitary-adrenal cortical activity as determinants of the dexamethasone suppression test response.

To determine the contribution of serum dexamethasone concentrations and hypothalamic-pituitary-adrenal cortical activity before dexamethasone administration to the dexamethasone suppression test (DST) response, a series of stepwise discriminant function analyses were performed for 40 patients with definite endogenous depression and 40 matched normal control subjects. The 24-hour serum cortisol concentration before dexamethasone administration and the serum dexamethasone concentrations at 8, 16, and 24 hours after administration served as the independent variables, and the DST "escaper"/"suppressor" dichotomy served as the dependent variable. While both types of independent variables significantly influenced the DST response, the major factor that contributed to the discrimination of escapers from suppressors was the 24-hour cortisol concentration before dexamethasone administration. Sixteen hours after dexamethasone administration, when the DST had the highest positive predictive value, serum dexamethasone concentrations significantly influenced DST outcome only when they were below a certain threshold level. At this time, hypothalamic-pituitary-adrenal cortical hyperactivity before dexamethasone administration accounted for approximately two thirds of the incidence of DST nonsuppression.

Adrenal gland volume in major depression. Increase during the depressive episode and decrease with successful treatment.

BACKGROUND: Hyperactivity of the pituitary-adrenocortical axis is the most prominent neuroendocrine abnormality in major depression. It is state-related, returning to normal with resolution of the depressive episode. Adrenal gland enlargement also has been reported in patients with major depression and has been hypothesized as an index of cumulative lifetime depression. However, whether or not adrenal enlargement decreases with successful treatment of depression has not yet been studied, to our knowledge. We, therefore, determined adrenal gland volume in patients with major depression before and after treatment and in matched normal controls, and compared adrenal size with functional indexes of pituitary-adrenocortical activity. METHODS: Adrenal volumes were measured by magnetic resonance imaging in nine adult and two adolescent patients with major depression during their illness and during full remission when medication had been stopped for at least 1 month, and in nine adult and two adolescent normal control subjects individually matched to the patients. Basal, 4 to 7 PM plasma corticotropin 1-39 and cortisol levels, and corticotropin 1-39 and cortisol responses to administration of ovine corticorelin and lowdose cosyntropin also were measured. RESULTS: Mean adrenal gland volume was significantly larger, by about 70% in the patients while depressed than after successful treatment, and it also was significantly larger, again by about 70%, than the mean adrenal gland volume of their matched controls. After treatment, the mean adrenal volume of the patients decreased and was no longer significantly different from that of their controls at baseline. The magnitude of the decrease was significantly positively correlated with the duration of the depressive episode. Basal, late-afternoon plasma corticotropin 1-39 levels were significantly lower in the patients while depressed than in their matched controls, but basal plasma cortisol levels did not differ significantly among the three groups, nor did the corticotropin 1-39 and cortisol responses to corticorelin or the cortisol response to cosyntropin. Correlations between adrenal gland volume and basal corticotropin and cortisol levels, and the corticotropin and cortisol responses to hormone challenge, were not consistently in the expected direction in any of the three groups of subjects. CONCLUSIONS: Adrenal gland enlargement occurring during an episode of major depression appears to be state-dependent, in that it reverts to the normal size range during remission after treatment. It thus does not appear to be an index of cumulative lifetime depression. The lack of a discernible relationship between adrenal volume and pituitary-adrenocortical activity remains to be explained and might be related to noncorticotropin influences on the adrenal gland, including other tropic hormones and/or neural mechanisms.

Secondary depression in panic disorder and agoraphobia. I. Frequency, severity, and response to treatment.

Depressive symptomatology in 481 subjects with panic disorder and phobic avoidance was studied as part of an investigation of the efficacy of alprazolam in panic disorder. Subjects who had a major depressive episode (MDE) before the onset of their panic disorder were not included in the trial. With this exclusion criterion, 31% of subjects had a secondary MDE occurring after the onset of the panic disorder. The occurrence of secondary MDE was related to the length of time subjects were ill with panic disorder. Compared with the subjects without depression, those subjects with current MDE had higher scores on measures of anxiety and depression but not on the number of panic attacks per week. The presence of depression and the degree of phobic avoidance contributed independently to measures of the severity of the panic illness. Alprazolam was effective in reducing panic and depressive symptomatology in both depressed and nondepressed subjects with panic disorder. The presence of an MDE was not predictive of the outcome of treatment for the panic and phobic symptoms. Subjects with or without depression responded similarly to alprazolam.

Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety.

In a multicenter placebo-controlled study, the safety, side effects, and patient acceptance of alprazolam for the treatment of panic disorder and agoraphobia were examined. A total of 525 patients meeting DSM-III criteria for agoraphobia with panic attacks or panic disorder were randomly assigned to receive alprazolam or placebo, which they took for eight weeks. The mean daily dose at the end of the study was 5.7 mg of alprazolam or 7.5 capsules of placebo daily. Potentially serious reactions to alprazolam occurred in ten of 263 subjects who received the drug. These included acute intoxication (three), hepatitis (two), mania (two), amnesia (one), aggressive behavior (one), and depression (one). Treatment-related side effects that were worse in patients taking alprazolam than in those taking placebo included sedation, fatigue, ataxia, slurred speech, and amnesia. Sedation was the most frequent but tended to subside with dose reduction or continued administration of the drug. Patient acceptance of alprazolam, as measured by the rate of completion for study participants, was high. Eighty-four percent of patients receiving active drug completed the study compared with 50% receiving placebo.

beta-Endorphin and schizophrenia.

To study the effects of beta-endorphin in chronic schizophrenia, nine male patients participated in a double-blind crossover comparison of a single intravenous 20-mg injection of beta-endorphin and saline. Bolus injection of beta-endorphin from an albumin-coated syringe produced markedly higher plasma concentrations than did slow intravenous infusion from a non-albumin-coated syringe. Beta-endorphin intravenously injected in nine patients produced a statistically significant increase in serum prolactin levels. In one patient, both 10 mg of morphine sulfate and 20 mg of beta-endorphin produced similar increases in the alpha power of the EEG. In eight patients, beta-endorphin administration was associated with a statistically significant but not clinically obvious improvement in schizophrenic symptoms.

Optimal statistical design of radioimmunoassays and competitive protein-binding assays.

The statistical analysis of radioimmunoassay and competitive protein binding assay data is complex. Because the response variable (percent counts) is not lineraly related to log dose, a logit transformation of the response variable usually is performed to permit linear regression analysis. This transformation induces marked heterogeneity of variance, so that iterative weighted regression programs have been used to achieve the best standard curve and the most precise dose estimates of unknowns. In this study several parameters of assay design are investigated in order to establish those designs yielding antigen concentration estimates of highest precision as well as estimates of comparable precision by either simple linear regression analysis or by the more complex weighted regression technique. Unknown estimates of highest precision are obtained when 1) the present counts of the standard doses covers a range of approximately 80 percent to 20 percent, 2) the number of standard dose levels is eight or more, 3) the number of replicates at each dose level is two or more, and 4) the percent counts of the unknowns also are within the range 80 percent ot 20 percent. Under these conditions, also, simple linear regression yields unknown estimates of comparable precision to weighted regression and therefore may be safely used.

Neonatal dexamethasone administration. I. Temporary delay of development of the circadian serum corticosterone rhythm in rats.

A series of experiments was undertaken to examine the effects of neonatal dexamethasone administration on the development of the circadian serum corticosterone rhythm in rats. Initial experiments showed that the rhythm began normally on postnatal day 18 in untreated animals. Then 1-day-old rats were injected sc with dexamethasone acetate (1, 10, or 100 microgram), dexamethasone phosphate (1, 3, or 5 microgram) beginning on day 1. Appropriate vehicle controls were included. At most doses and dosage regimens, rat pups were sacrificed at 0700 and 1900 h on postnatal days 16, 18, 20, and 22, but at the highest doses, they were sacrificed only on days 25 and 30. The single dexamethasone acetate injection (100 microgram) delayed the appearance of the corticosterone rhythm for 2 days compared to that in the vehicle-injected controls. Similarly, the 3 consecutive injections of dexamethasone phosphate (5 microgram) delayed the appearance of the rhythm for 4 days. All other dexamethasone dosage regimens were ineffective in altering the onset of the circadian corticosterone rhythm.

Neonatal dexamethasone administration. II. Persistent alteration of circadian serum anterior pituitary hormone rhythms in rats.

Newborn male rats were treated SC with dexamethasone phosphate (100 microgram) or dexamethasone acetate (100 microgram) on postnatal day 1, dexamethasone phosphate (5.0 microgram) opn postnatal days 1, 2, 3, or the corresponding drug vehicle. All animals were sacrificed 65-70 days later at previously determined daily trough and peak times of serum LH, TSH, and corticosterone: 0700 and 0100 h for LH, 0700 and 1300 h for TSH, and 0700 and 1900 h for corticosterone. None of the three dexamethasone treatment regimens affected the circadian variation of serum LH or corticosterone. Dexamethasone phosphate (100 microgram) altered the normal circadian rhythm of serum TSH in the adult animals, but the other two dexamethasone treatments did not affect the TSH rhythm. Basal 0700 h serum levels of FSH, PRL, and GH were also measured in these animals; none of the dexamethasone treatments altered the levels of these hormones compared to levels in the vehicle-injected controls.

Lack of arginine vasopressin response to central dopamine blockade in normal adults.

Haloperidol, a central nervous system dopamine blocker, was given im to seven normal volunteers at a dose level (1.0 mg) known to have central nervous system effects. Plasma PRL levels rose sharply in response to haloperidol, but plasma arginine vasopressin levels did not change significantly. These data do not support the hypothesis of a prominent dopamine neurotransmitter regulation of arginine vasopressin secretion.