ABSTRACT
Hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity measured by the combined dexamethasone-CRH test (DEX-CRH test) has been found in patients with major depressive disorder (MDD), whereas hypoactivity has been found in patients with work-related stress. We aimed to investigate the DEX-CRH test as a biomarker to distinguish between MDD and work-related stress (exhaustion disorder - ED). We hypothesized that there would be lower cortisol and ACTH response in participants with ED compared to MDD and healthy controls (HC). Also, we explored if the cortisol response of those patients interacted with robust markers of oxidative stress. Thirty inpatients with MDD and 23 outpatients with ED were recruited. Plasma cortisol and ACTH were sampled during a DEX-CRH test. The main outcome measure, area under the curve (AUC) for cortisol and ACTH, was compa-red between MDD vs. ED participants and a historical HC group. Secondary markers of oxidative stress urinary 8-oxodG and 8-oxoGuo; quality of sleep and psychometrics were obtained. Cortisol concentrations were higher in MDD and ED participants compared to HC, and no differences in AUC cortisol and ACTH were found between ED vs. MDD. Compared to ED, MDD participants had higher stress symptom severity and a lower sense of well-being. No differences in oxidative stress markers or quality of sleep between the groups were found. The result indicates that the patients with ED, like patients with MDD, are non-suppressors in DEX-CRH test and not hypocortisolemic as suggested.
Subject(s)
Adrenocorticotropic Hormone , Biomarkers , Depressive Disorder, Major , Dexamethasone , Hydrocortisone , Oxidative Stress , Humans , Depressive Disorder, Major/blood , Depressive Disorder, Major/physiopathology , Depressive Disorder, Major/diagnosis , Female , Male , Hydrocortisone/blood , Adult , Oxidative Stress/physiology , Adrenocorticotropic Hormone/blood , Biomarkers/blood , Dexamethasone/pharmacology , Middle Aged , Corticotropin-Releasing Hormone/blood , Occupational Stress/physiopathology , Hypothalamo-Hypophyseal System/physiopathology , Hypothalamo-Hypophyseal System/metabolism , Pituitary-Adrenal System/physiopathologyABSTRACT
Brain injury following head trauma is a potential cause of acquired hypopituitarism, although regarded as uncommon. Consequently, such patients do not routinely undergo neuroendocrine evaluation. Recent data suggest hypopituitarism to be more common than previously stated, with a prevalence of at least 25% in long-term survivors. As untreated hypopituitarism is likely to delay recovery and rehabilitation, this calls for a change in the current management of patients suffering traumatic brain injury. In this article, we will review current knowledge in this field.
