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The Combined Dexamethasone‐Suppression/CRH‐Stimulation Test in Alcoholics During and After Acute Withdrawal
Author(s) -
Hundt W.,
Zimmermann U.,
Pöttig M.,
Spring K.,
Holsboer F.
Publication year - 2001
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/j.1530-0277.2001.tb02268.x
Subject(s) - dexamethasone , medicine , endocrinology , dexamethasone suppression test , corticotropin releasing hormone , vasopressin , stimulation , hormone , adrenocorticotropic hormone , psychology
Background: Chronic alcoholism is often accompanied by disturbances of the hypothalamic‐pituitary‐adrenal (HPA) system. Patients with alcoholism frequently show nonsuppression in the dexamethasone (Dex) suppression test and also a blunted increase of adrenocorticotropin (ACTH) after injection of corticotropin‐releasing hormone ( h CRH). However, the underlying mechanisms have not been fully elucidated. The combined Dex/CRH test (pretreatment with 1.5 mg dexamethasone at 2300 hr, injection of 100 μg h CRH at 1500 hr the next day) has been established as a more sensitive tool to investigate HPA system regulation in depressed patients. Methods: We studied the effect of the combined Dex/CRH test in 19 alcoholic inpatients (9 male, 10 female) during and after withdrawal along with 19 healthy controls. Results: Compared to normal controls, patients showed a severely dysregulated HPA system during withdrawal, with significantly elevated cortisol and ACTH response to h CRH after pretreatment with dexamethasone. After completed withdrawal, cortisol levels after injection of h CRH were almost normalized while ACTH values were partially lower in patients, compared to controls. Conclusions: We conclude that the HPA system is severely disturbed during alcohol withdrawal, possibly reflecting an exaggerated release of hypothalamic corticotropin and vasopressin.