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Br J Psychiatry. 2004 Jun;184:496-502.

Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder.

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  • 1The Stanley Research Centre, University of Newcastle upon Tyne, The Royal Victoria Infirmary, Newcastle upon Tyne, UK.

Abstract

BACKGROUND:

Hypothalamic-pituitary-adrenal (HPA) axis function, as variously measured by the responses to the combined dexamethasone/corticotrophin-releasing hormone (dex/CRH) test, the dexamethasone suppression test (DST) and basal cortisol levels, has been reported to be abnormal in bipolar disorder.

AIMS:

To test the hypothesis that HPA axis dysfunction persists in patients in remission from bipolar disorder.

METHOD:

Salivary cortisol levels and the plasma cortisol response to the DST and dex/CRH test were examined in 53 patients with bipolar disorder, 27 of whom fulfilled stringent criteria for remission, and in 28 healthy controls. Serum dexamethasone levels were measured.

RESULTS:

Patients with bipolar disorder demonstrated an enhanced cortisol response to the dex/CRH test compared with controls (P=0.001). This response did not differ significantly between remitted and non-remitted patients. These findings were present after the potentially confounding effects of dexamethasone levels were accounted for.

CONCLUSIONS:

The dex/CRH test is abnormal in both remitted and non-remitted patients with bipolar disorder. This measure of HPA axis dysfunction is a potential trait marker in bipolar disorder and thus possibly indicative of the core pathophysiological process in this illness.

PMID:
15172943
[PubMed - indexed for MEDLINE]
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