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Enhanced Adrenal Sensitivity to Exogenous Cosyntropin (ACTH 1-24) Stimulation in Major Depression

Relationship to Dexamethasone Suppression Test Results

Richard S. Jaeckle, MD; Roger G. Kathol, MD; Juan F. Lopez, MD; William H. Meller, MD; Steven J. Krummel, MD

Arch Gen Psychiatry. 1987;44(3):233-240.

Abstract
• ACTH ^1-24 (cosyntropin) (250 µg by intravenous bolus) was given to 38 medicated patients with major depressive disorder (MDD) and to 34 normal control subjects. Patients with MDD had significantly higher plasma cortisol concentrations and significantly higher increases in plasma cortisol levels 60 minutes after cosyntropin infusion than did control subjects. Patients who were nonsuppressors in the dexamethasone suppression test had significantly higher 60-minute cortisol concentrations and cortisol increases than did normal subjects and patients with MDD who were suppressors. There were significant, strongly positive correlations between cortisol secretory responses to cosyntropin and postdexamethasone cortisol concentrations in patients with MDD. These findings confirm that adrenal sensitivity to corticotropin (ACTH) is enhanced in MDD and suggest that this endocrine abnormality may be related pathophysiologically to the resistance of cortisol secretion to dexamethasone suppression.

Author Affiliations
From the Departments of Psychiatry (Drs Jaeckle, Kathol, Lopez, Meller, and Krummel) and Internal Medicine (Dr Kathol), and the Neuroscience Program (Dr Jaeckle), College of Medicine, University of Iowa, Iowa City.

Footnotes
Accepted for publication March 17, 1986.

Reprint requests to Department of Psychiatry, University of Iowa College of Medicine, 500 Newton Rd, Iowa City, IA 52242 (Dr Jaeckle).

References 1, 2, 4, 5, 8,10,11, 20-30.

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