Activation of the hypothalamus-pituitary-adrenocortical system is a biological core symptom of depression. Although the regulation of cortisol secretion is well studied in this condition, there is no information about the diurnal activity of dehydroepiandrosterone (DHEA) secretion. Therefore, we studied 24-h DHEA plasma concentrations (every 30 min) in severely depressed patients (n ϭ 26) and healthy controls (n ϭ 33).We found depression to significantly increase diurnal minimal and mean DHEA plasma concentrations, whereas there was no effect on the diurnal maximal plasma concentration and the diurnal amplitude of DHEA. In particular, we found a parallel increase in mean DHEA (5.8 Ϯ 3.6 vs. 3.4 Ϯ 1.9 nmol/L; P Ͻ 0.003), cortisol (286 Ϯ 65 vs. 184 Ϯ 29 nmol/L; P Ͻ 0.0001) and ACTH (7.14 Ϯ 2.06 vs. 5.72 Ϯ 1.36 pmol/L; P Ͻ 0.002) plasma concentrations.The novel finding of parallel increases in diurnal DHEA and cortisol plasma concentrations in depressed patients has important implications for the regulation of the hypothalamus-pituitary-adrenocortical system in conditions of chronic stress and for the rationale of DHEA treatment in depressed patients. (J Clin Endocrinol Metab 83: 3130 -3133, 1998) T HE ADRENAL cortex secretes various steroid hormones with differing glucocorticoid, mineralocorticoid, and androgen properties. Neuroendocrine studies in affective disorders are mainly focussed on the well known hypercortisolemia as a consequence of the dysregulation of the hypothalamus-pituitary-adrenocortical (HPA) system, which is evident from studies of basal secretory activity (1) and feedback regulation (2). However, there is only sparse information about the regulation of the secretion of other adrenal steroid hormones in depression, especially dehydroepiandrosterone (DHEA), whose sulfated form (DHEAS) is the most abundant steroid hormone in man.Studies using single point measurements found that plasma DHEA and DHEAS concentrations were not different in depressed patients and healthy controls (3, 4). In contrast, in a small group of depressed patients with psychotic features, plasma DHEA was increased (5). This finding is in accordance with a report about elevated 24-h urinary DHEAS (6) in depressed patients.It is assumed that ACTH is an important regulator of the secretion of adrenal androgens. However, there are several instances, such as adrenarche, puberty, normal aging, and acute stress, where a dissociation between the effects of ACTH on adrenal androgens, such as DHEA, and adrenal glucocorticoids, such as cortisol, has been observed (7-9).Additionally, clarifying the specific features of the regulation of DHEA in depressed patients seems necessary to better understand the possibly beneficial effect of DHEA treatment in this group of patients (10). Therefore, we studied diurnal profiles of DHEA in a large group of drug-free depressed patients and in a gender-and age-matched group of healthy controls.
Subjects and Methods SubjectsThis study was approved by the local ethics committee, and all subje...
