The Cortisol and ACTH Response to Dex/CRH Testing in Women With and Without Perimenopausal Depression

Abstract

Background Abnormalities in the hypothalamic pituitary-adrenal (HPA) axis are frequent accompaniments of depression, and studies have documented the role of stress and stressful life events in the ontogeny of perimenopausal depressions (PMD). Since HPA axis function in women is further modulated by both aging and ovarian steroids, it is possible that a dysregulated HPA axis contributes to the increased risk of PMD. Objective We examined HPA axis function in perimenopausal women with and without depression using the combined dexamethasone-CRH (Dex/CRH) test. Methods Dex/CRH tests were performed on 20 women with PMD and 20 women who were also perimenopausal but without current or past depression (control women). Main outcome measures were plasma levels of cortisol and ACTH and 24-hour urinary free cortisol. Five women took chronic stable medications, otherwise all women were medically healthy, and both groups were comparable with respect to reproductive stage and age. Standardized symptom rating scales were administered to each woman prior to Dex/CRH testing. Results No group differences were present in either baseline or stimulated ACTH and cortisol secretion. Baseline plasma measures of estradiol, progesterone and 24-hour UFC levels similarly did not differ in PMD and control women. Discussion Despite reports of increased stress responsiveness in PMD, we observed no abnormalities of HPA axis activity associated with PMD compared with women without depression. These findings suggest that PMD is not uniformly associated with HPA dysregulation and could reflect underlying pathophysiologic processes that are distinct from women with non-reproductive-related depressions.

The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions

“…An experimental study ( 227 ) examined HPA axis function in perimenopausal women with and without current or past depression using the combined dexamethasone-corticotropin-releasing hormone (Dex/CRH) test. The two groups did not differ in either baseline or stimulated ACTH, nor cortisol secretion.…”

Neuroendocrine pathogenesis of perimenopausal depression

“…It has antidepressant-like effect, which may be related to the regulation of monoamine nerve transposition system in the brain ( 124 ). Contrary to the traditional idea, Guerrierieri GM ( 125 ) tested the HPA axis function of perimenopausal women with and without depression using the combined dexamethasone-adrenocorticotropin releasing hormone test. It was found that there was no inter-group difference in both baseline and stimulated ACTH and cortisol secretion.…”

Prophylactic Effects of Hemp Seed Oil on Perimenopausal Depression: A Role of HPA Axis

“…Under the state of stress, the HPA axis is activated and stimulates the release of CRH from paraventricular hypothalamic nucleus neurons, then CRH induces the anterior pituitary gland to secrete ACTH. After ACTH enters the peripheral circulation system, it promotes adrenal cortex to produce CORT 25) . More serious HPA axis dysregulation has been observed in females under chronic stress, accompanied by the increase of ACTH and CORT levels 26) .…”