Dexamethasone Suppression Test before and after Partial Sleep Deprivation in Depressed Schizophrenic and Schizoaffective Patients

After evaluating a patient who appeared to have a falsely abnormal response to the dexamethasone suppression test while taking troglitazone, we examined the effects of troglitazone on the activity of hepatic CYP3A4 and the screening tests for Cushing’s syndrome. We studied five healthy women and three healthy men, aged 25 ± 2 yr, before and after treatment with troglitazone (600 mg daily) for 28 d. Baseline 0800 h cortisol and corticosterone were similar before and after troglitazone treatment. Before troglitazone treatment, all subjects suppressed 0800 h cortisol below 1.8 μg/dl (mean, 0.66 ± 0.08 μg/dl) during the 1-mg overnight dexamethasone suppression test (DST), whereas during troglitazone treatment none of the subjects suppressed 0800 h cortisol below 1.8 μg/dl (mean, 9.0 ± 1.8 μg/dl). Serum dexamethasone levels decreased by 66 ± 4%, and the erythromycin breath test measurements increased by 27 ± 8%, indicating increased CYP3A4 activity during troglitazone treatment. The hydrocortisone suppression test (HST) was performed by administering 50 mg hydrocortisone at 2300 h. Using the criterion of suppression of 0800 h plasma corticosterone by more than 50%, the specificity of the HST was 100% both before and after troglitazone treatment. In conclusion, troglitazone induced the activity of CYP3A4 leading to falsely abnormal DST. HST is a useful alternative to the DST in patients taking medications that increase the activity of CYP3A4.

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Postdexamethason intact and multisequentia ACTH in melancholia

Acta Neuropsychiatrica ◽

10.1017/s0924270800034414 ◽

1991 ◽

Vol 3 (1) ◽

pp. 8-13

Author(s):

M. Maes ◽

C. Vandervorst ◽

E. Suy ◽

M. Martin ◽

B. Minner ◽

...

Keyword(s):

Clinical Practice ◽

Plasma Levels ◽

Clinical Relevance ◽

Plasma Cortisol ◽

Adrenocorticotropic Hormone ◽

Severity Of Illness ◽

Dexamethasone Suppression Test ◽

Before And After ◽

Suppression Test ◽

Dexamethasone Suppression

SummaryThe dexamethasone suppression test has been carried out in 111 depressed inpatients. Fasting, 8 a.m. plasma levels of Cortisol and adrenocorticotropic hormone (ACTH) were determined before and after administration of 1 mg dexamethasone. In 64 subjects multisequential (1-17,1-24,1-39) ACTH, and in 47 subjects intact (1-39) ACTH has been determined. Patients with melancholia exhibited significantly higher postdexamethasone Cortisol and intact ACTH values as compared with minor and simple major depressives. Severity of illness was significantly and positively related to postdexamethasone intact ACTH - but not to multisequential ACTH. Cortisol nonsuppressors showed higher postdexamethasone (only intact) ACTH values than Cortisol suppressors. Both postdexamethasone ACTH values were significantly and positively related with the postdexamethasone Cortisol values. We have established that Cortisol nonsuppression during melancholia is determined by an augmented escape of ACTH from suppression by dexamethasone. Intact ACTH showed the most significant clinical relevance for depression and Cortisol nonsuppression. In the clinical practice we advize the use of postdexamethasone intact ACTH in stead of plasma Cortisol or multisequential ACTH.

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Effects of the Introduction of the Dexamethasone Suppression Test on Diagnosis and Treatment of Depression by Psychiatrists

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048678309160012 ◽

1983 ◽

Vol 17 (4) ◽

pp. 350-353

Author(s):

Geoffrey D. Schrader ◽

Timothy C. Durbridge

Keyword(s):

Psychiatric Disorders ◽

Laboratory Tests ◽

Strong Association ◽

Dexamethasone Suppression Test ◽

Treatment Practice ◽

Treatment Of Depression ◽

Before And After ◽

Management Plans ◽

Suppression Test ◽

Dexamethasone Suppression

A review of case notes before and after the introduction of the DST into clinical psychiatric practice revealed considerable changes in diagnosis and management. Specifically there were increases in the diagnosis of biological depression and treatment with somatic antidepressant therapy. There was no association between DST results and particular management plans. There was a strong association between requesting the DST and management with antidepressants. It is suggested that the introduction of laboratory tests for psychiatric disorders may firm the belief of psychiatrists in the biological basis of some forms of depression and thus alter their diagnostic and treatment practice.

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DHEAS and Differential Blood Counts as Indirect Signs of Glucocorticoid Excess in Adrenal Non-Producing Adenomas

Hormone and Metabolic Research ◽

10.1055/a-1539-6442 ◽

2021 ◽

Vol 53 (08) ◽

pp. 512-519

Author(s):

Eliza P. Winzinger ◽

Hana Jandikova ◽

Matthias Haase ◽

Andreas Knauerhase ◽

Tudor Winzinger ◽

...

Keyword(s):

Dexamethasone Suppression Test ◽

Adrenal Tumors ◽

Blood Concentrations ◽

Adrenocortical Adenomas ◽

Normal Individuals ◽

Before And After ◽

Suppression Test ◽

Almost All ◽

Dexamethasone Suppression ◽

Glucocorticoid Action

AbstractThe majority of incidentally discovered adrenal tumors are later characterized as non-producing adrenocortical adenomas (NPA). We asked whether laboratory abnormalities in parameters that reflect glucocorticoid action can be found in patients with NPA despite their nature of being clinically unapparent. Since glucocorticoids are potent immunosuppressants we studied blood counts and differential blood counts along with corticotropin and dehydroepiandrostenedione sulfate (DHEAS) blood concentrations, as well as cortisol values before and after an overnight 1 mg dexamethasone suppression test. We compared the results of normal individuals, of patients with adrenal adenomas and normal hormone profiles and with subclinical autonomous glucocorticoid hypersecretion, as well as overt cortisol excess. We found that almost all indices of the blood counts were significantly different between the patients groups. In particular, patients with adrenal non-producing adenomas already showed signs of glucocorticoid excess, including relative lymphocytopenia, lowered DHEAS, and ACTH concentrations than control individuals. We also found that the extent of lymphocytopenia correlated with the concentrations of DHEAS and ACTH, and DHEAS correlated well with ACTH. We conclude that the basal ACTH and DHEAS values along with the differential blood counts give good information on the extent of glucocorticoid excess and that silent adrenal adenomas seem to oversecrete glucocorticoids at concentrations that already alter these parameters.

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

The British Journal of Psychiatry ◽

10.1192/bjp.157.5.713 ◽

1990 ◽

Vol 157 (5) ◽

pp. 713-717 ◽

Cited By ~ 17

Author(s):

Isaac Schweitzer ◽

George I. Szmukler ◽

Kay P. Maguire ◽

Leonard C. Harrison ◽

Virginia Tuckwell ◽

...

Keyword(s):

Ideal Body Weight ◽

Significant Negative Correlation ◽

Dexamethasone Suppression Test ◽

Adrenocorticotrophic Hormone ◽

Plasma Acth ◽

Abnormal Result ◽

Before And After ◽

Suppression Test ◽

Ideal Body ◽

Dexamethasone Suppression

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.

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