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Pathophysiologic and Somatic Investigations of Hypothalamic‐Pituitary‐Adrenal Axis Activation in Patients with Depression
Author(s) -
MICHELSON DAVID,
GOLD PHILIP W.
Publication year - 1998
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1998.tb09610.x
Subject(s) - pathophysiology , medicine , exacerbation , endocrinology , hypothalamic–pituitary–adrenal axis , depression (economics) , glucocorticoid , multiple sclerosis , hormone , immunology , economics , macroeconomics
A bstract : Preclinical studies of inflammatory and autoimmune illnesses have demonstrated the importance of central components of the HPA axis in disease pathophysiology. The implications of these data for human illness are poorly understood. We have studied the pathophysiology of the hypercortisolism seen in two human illnesses involving the central nervous system, multiple sclerosis (MS) and depression, and looked for demonstrable somatic changes that may be associated with such hypercortisolism. Data from a study of medication‐free patients with multiple sclerosis not in acute exacerbation suggest that compared with depression, MS is associated with increased prominence of hypothalamic vasopressin secretion ( p < 0.05). Data from studies of depressed patients with mild to moderate hypercortisolism (assessed by 24‐hour urinary free cortisol excretion) demonstrate marked reductions in bone mineral density compared to healthy, carefully matched controls ( p < 0.001), as well as changes in markers of bone metabolic activity similar to those seen in patients with Cushing's disease or exogenous glucocorticoid treatment ( p < 0.05). Taken together, these studies suggest HPA axis dysregulations demonstrated in preclinical models of autoimmune and inflammatory illness also occur in human illness and may have important and lasting somatic sequelae.