The combined dexamethasone suppression-corticotropin-releasing hormone stimulation (DEX-CRH) test and traumatic stress
Leo Sher, M.D.
Posttraumatic stress disorder (PTSD) is associated with significant neuroendocrine changes including the hypothalamic-pituitary-adrenal (HPA) axis abnormalities (1). Several research groups have used the combined dexamethasone suppression-corticotropin-releasing hormone stimulation (DST–CRH) test to examine the HPA function in traumatized individuals.
Rinne et al. (2) investigated the relationship between childhood abuse and HPA axis function using the DEX-CRH test in borderline personality disorder (BPD) patients with and without a history of childhood abuse and comorbid posttraumatic stress disorder (PTSD) or MDD and healthy control subjects. Chronically abused BPD patients had a significantly enhanced ACTH and cortisol response to the DEX/CRH challenge compared with nonabused subjects. Comorbid PTSD significantly attenuated the ACTH response.
To evaluate the effect of PTSD on HPA-axis regulation, de Kloet et al. (3) compared the response to a DEX-CRH test between male veterans with PTSD and male veterans, who had been exposed to similar traumatic events during their deployment, without PTSD. Additionally, the authors compared the response of PTSD patients with and without comorbid MDD. The DEX-CRH test did not reveal HPA-axis abnormalities in PTSD patients as compared to trauma controls. PTSD patients with comorbid 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.
More recently, Klaassens et al. (4) explored whether trauma exposure was associated with alterations in HPA-axis functioning in the absence of lifetime psychiatric morbidity. The authors compared trauma-exposed healthy male subjects and non-exposed healthy male controls. No differences were found between both groups for plasma cortisol or ACTH responses to the DEX-CRH test.
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- Rinne T, de Kloet ER, Wouters L, Goekoop JG, DeRijk RH, van den Brink W. Hyperresponsiveness of hypothalamic-pituitary-adrenal axis to combined dexamethasone/corticotropin-releasing hormone challenge in female borderline personality disorder subjects with a history of sustained childhood abuse. Biol Psychiatry. 2002 Dec 1;52(11):1102-12.
- de Kloet C, Vermetten E, Lentjes E, Geuze E, van Pelt J, Manuel R, Heijnen C, Westenberg H. Differences in the response to the combined DEX-CRH test between PTSD patients with and without co-morbid depressive disorder. Psychoneuroendocrinology. 2008 Apr;33(3):313-20.
- Klaassens ER, Giltay EJ, van Veen T, Veen G, Zitman FG. Trauma exposure in relation to basal salivary cortisol and the hormone response to the dexamethasone/CRH test in male railway employees without lifetime psychopathology. Psychoneuroendocrinology, in press.