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The Dexamethasone Suppression Test in Anorexia Nervosa the Influence of Weight, Depression, Adrenocorticotrophic Hormone and Dexamethasone

Published online by Cambridge University Press:  02 January 2018

Isaac Schweitzer*
Affiliation:
Department of Psychiatry, University of Melbourne, Clinical Sciences Building, C/- PO, Royal Melbourne Hospital, Victoria, Australia, 3050
George I. Szmukler
Affiliation:
Department of Psychiatry, University of Melbourne
Kay P. Maguire
Affiliation:
Department of Psychiatry, University of Melbourne
Leonard C. Harrison
Affiliation:
Burnet Clinical Research Unit, Walter and Eliza Hall Institute of Medical Research, Melbourne
Virginia Tuckwell
Affiliation:
Department of Psychiatry, University of Melbourne
Brian M. Davies
Affiliation:
Department of Psychiatry
*
Correspondence

Abstract

When 20 female anorexic in-patients were investigated with weekly DSTs, 10 had an abnormal result at initial testing. There was no identifiable relationship between severity of weight loss and DST status; % ideal body weight was no different between suppressors and non-suppressors. There was no consistent relationship between normalisation of the DST response and weight gain. Depressive symptoms were common, with half the patients scoring 20 or more on the HRSD. Plasma ACTH concentrations before and after the DST were normal. There was a significant negative correlation between plasma dexamethasone concentrations and pre- and post-dexamethasone plasma Cortisol concentrations.

Type
Papers
Copyright
Copyright © The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Berger, M., Pirke, K-M., Doerr, P., et al (1984) The limited utility of the dexamethasone suppression test for the diagnostic process in psychiatry. British Journal of Psychiatry, 145, 372382.Google Scholar
Biederman, J., Rivinus, T., Kemper, K., et at (1985) Depressive disorders in relatives of anorexia nervosa patients with and without a current episode of nonbipolar major depression. American Journal of Psychiatry, 142, 14951497.Google Scholar
Boyar, R. M., Hellman, L. D., Roffwarg, H., et al (1977) Cortisol secretion and metabolism in anorexia nervosa. New England Journal of Medicine, 296, 190193.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F., et al (1981a) A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. Archives of General Psychiatry, 38, 1522.Google Scholar
Carroll, B. J., Feinberg, M. & Smouse, P. E. (1981b) The Carroll Rating Scale for Depression 1. Developments, reliability and validation. British Journal of Psychiatry, 138, 194200.CrossRefGoogle Scholar
Danowski, T. S., Livingstone, E., Gonzales, A. R., et al (1972) Fractional and partial hypopituitarism in anorexia nervosa. Hormones, 3, 105118.Google Scholar
Gerner, R. H. & Gwirtsman, H. E. (1981) Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia. American Journal of Psychiatry, 138, 650653.Google Scholar
Gershon, E. S., Schreiber, J. L. & Hamovit, J. R. (1984) Clinical findings in patients with anorexia nervosa and affective illness in their relatives. American Journal of Psychiatry, 141, 14191422.Google Scholar
Gold, M. S., Pottash, A. L. C., Martin, D. M., et al (1980/81) Thyroid stimulating hormone and growth hormone responses to thyrotropin releasing hormone in anorexia nervosa. International Journal of Psychiatry in Medicine, 10, 5157.Google Scholar
Gold, P. W., Gwirtsman, H., Avgerinos, P. C., et al (1986) Abnormal hypothalamic–pituitary–adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients. New England Journal of Medicine, 314, 13351342.Google Scholar
Gwirtsman, H. E. & Gerner, R. H. (1981) Neurochemical abnormalities in anorexia nervosa: similarities to affective disorders. Biological Psychiatry, 16, 991995.Google ScholarPubMed
Halmi, K. A., Dekirmenjian, H., Davis, J. M., et al (1978) Catecholamine metabolism in anorexia nervosa. Archives of General Psychiatry, 35, 458.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.CrossRefGoogle ScholarPubMed
Holsboer, F., Haack, D., Gerken, A., et al (1984) Plasma dexamethasone concentrations and differential suppression response of Cortisol and corticosterone in depressives and controls. Biological Psychiatry, 19, 281291.Google Scholar
Hotta, M., Shibasaki, T., Masuda, A., et al (1986) The responses of plasma adrenocorticotrophic and Cortisol to corticotrophin releasing hormone (CRH) and cerebrospinal fluid immunoreactive CRH in anorexia nervosa patients. Journal of Clinical Endocrinology and Metabolism, 62, 319324.Google Scholar
Johnson, G. F., Hunt, G., Kerr, K., et al (1984) Dexamethasone suppression test and plasma dexamethasone levels in depressed patients. Psychiatry Research, 13, 305313.Google Scholar
Kirstein, L. (1981) Diagnostic issues in anorexia nervosa. International Journal of Psychiatry in Medicine, 11, 235244.Google Scholar
Macaron, C., Wilber, J. F., Green, O., et al (1978) Studies of growth hormone, thyrotropin, and prolactin secretion in anorexia nervosa. Psychoneuroendocrinology, 3, 181185.Google Scholar
Maguire, K. P., Schweitzer, I., Biddle, N., et al (1987) The dexamethasone suppression test: importance of dexamethasone concentrations. Biological Psychiatry, 22, 957967.Google Scholar
Metropolitan, Life Insurance Co. (1959) New height standards for men and women. Statistical Bulletin, 40, 14.Google Scholar
Mullen, P. E., Linsell, C. R. & Parker, D. (1986) Influence of sleep disruption and calorie restriction on biological markers for depression. Lancet, ii, 10511055.Google Scholar
Poland, R. E., Rubin, R. T., Lesser, I. M., et al (1987) Neuroendocrine aspects of primary endogenous depression. II. Serum dexamethasone concentrations and hypothalamic–pituitary–adrenal cortical activity as determinants of the dexamethasone suppression test response. Archives of General Psychiatry, 44, 790795.Google Scholar
Privetera, W. N., Greden, J. F., Gardner, R. W., et al (1982) Interference by carbamazepine with the dexamethasone suppression test. Biological Psychiatry, 17, 611.Google Scholar
Schweitzer, I., Maguire, K. P., Tiller, J. W. G., et al (1986) The effects of weight change on the dexamethasone suppression test in depressed and anorexic patients. British Journal of Psychiatry, 149, 751755.Google Scholar
SPSSx inc. (1986) SPSSx User's Guide. New York: McGraw-Hill.Google Scholar
Tiller, J. G. W., Maguire, K. P., Schweitzer, I., et al (1988) The dexamethasone suppression test: a study in a normal population. Psychoneuroendocrinology, 13, 377384.Google Scholar
Taylor, T., Dluhy, R. G. & Williams, G. H. (1983) β-endorphin suppresses adrenocorticotropin and Cortisol levels in normal human subjects. Journal of Clinical Endocrinology and Metabolism, 57, 592596.Google Scholar
Walsh, B. T. (1982) Endocrine disturbances in anorexia nervosa and depression. Psychosomatic Medicine, 44, 8591.Google Scholar
Walsh, B. T., Katz, J. L., Levin, J., et al (1978) Adrenal activity in anorexia nervosa. Psychosomatic Medicine, 40, 499506.Google Scholar
Walsh, B. T., Roose, S. P., Katz, J. L., et al (1987) Hypothalamic-pituitary–adrenal–cortical activity in anorexia nervosa and bulimia. Psychoneuroendocrinology, 12, 131140.Google Scholar
Warren, M. P. & van de Wiele, R. L. (1973) Clinical and metabolic features of anorexia nervosa. American Journal of Obstetrics and Gynecology, 117, 435449.Google Scholar
Weiner, H. (1985) The physiology of eating disorders. International Journal of Eating Disorders, 4, 347388.Google Scholar
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