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II. Serum Dexamethasone Concentrations and Hypothalamic-Pituitary-Adrenal Cortical Activity as Determinants of the Dexamethasone Suppression Test Response

Russell E. Poland, PhD; Robert T. Rubin, MD, PhD; Ira M. Lesser, MD; Leslie A. Lane; Pamela J. Hart, MS

Arch Gen Psychiatry. 1987;44(9):790-795.

Abstract
• To determine the contribution of serum dexamethasone concentrations and hypothalamic-pituitary-adrenal cortical activity before dexamethasone administration to the dexamethasone suppression test (DST) response, a series of stepwise discriminant function analyses were performed for 40 patients with definite endogenous depression and 40 matched normal control subjects. The 24-hour serum cortisol concentration before dexamethasone administration and the serum dexamethasone concentrations at 8, 16, and 24 hours after administration served as the independent variables, and the DST "escaper"/"suppressor" dichotomy served as the dependent variable. While both types of independent variables significantly influenced the DST response, the major factor that contributed to the discrimination of escapers from suppressors was the 24-hour cortisol concentration before dexamethasone administration. Sixteen hours after dexamethasone administration, when the DST had the highest positive predictive value, serum dexamethasone concentrations significantly influenced DST outcome only when they were below a certain threshold level. At this time, hypothalamic-pituitary-adrenal cortical hyperactivity before dexamethasone administration accounted for approximately two thirds of the incidence of DST nonsuppression.

Author Affiliations
From the Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, Calif.

Footnotes
Accepted for publication April 15, 1987.

Reprint requests to Department of Psychiatry, Harbor-UCLA Medical Center, 1000 W Carson St, Building F-5, Torrance, CA 90509 (Dr Poland).

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