The Dexamethasone Suppression Test in the Puerperium

Abstract

A consecutive series of 45 women admitted to an obstetric unit were given the dexamethasone suppression test (DST) on days three to five post-partum, 82% being abnormal. The likelihood of an abnormal DST on one or both occasions increased linearly across the days of testing. Subjects completed the Beck self-report depression measure and the General Health Questionnaire at baseline and at six weeks. Baseline cortisol levels were not associated with baseline morbidity as assessed on the questionnaires and were not predictive of morbidity assessed at the six-week follow-up. It is concluded that the immediate post-partum period be included as a false-positive influence on the DST.

Regulation of mRNA expression encoding chaperone and co-chaperone proteins of the glucocorticoid receptor in peripheral blood: association with depressive symptoms during pregnancy

“…These changes are paralleled by decreases of GR sensitivity in peripheral blood cells over pregnancy, confirming the results of investigations performed over two decades ago of GR sensitivity in pregnancy using the DST (Greenwood & Parker, 1984 ;Smith et al 1987). These findings need to be replicated in a healthy control group to extrapolate results for euthymic, unmedicated patients to the general population.…”

“…Elevated progesterone levels partially attenuate the effects of rising free cortisol levels via competitive inhibition at the glucorticoid receptor (GR) (Rousseau et al 1972 ;Duncan & Duncan, 1979 ;Keller-Wood et al 1988). Diminished GR sensitivity in the second and third trimesters, as indicated by dexamethasone suppression test (DST) results, also attenuates the effect of elevated free cortisol (Greenwood & Parker, 1984 ;Smith et al 1987 ;Allolio et al 1990 ;O'Hara et al 1991). Given the complexity of altered responses of the HPA axis during pregnancy, and the many levels of compensatory regulation, we hypothesize that small differences in mechanisms that compensate for elevated free cortisol during pregnancy could contribute to risk for development of maternal depressive symptoms.…”

Maternal Plasma and Milk Free Cortisol during the First 3 Days of Breast-Feeding following Spontaneous Delivery or Elective Cesarean Section

“…In fact, during early postpartum days, the women's HPA axis does not respond to the dexamethasone suppression test [ 18].…”

Management of Adrenal Tumors in Pregnancy

“…3,38,39 In pregnant women without CS, only 40% had a suppression of plasma cortisol after a 1-mg dexamethasone suppression test (DST), a blunting effect that increased with advancing gestational age. 17,40 In one study, up to 82% of healthy pregnant women had an abnormal 1 mg DST in the peripartum period 41 ; this effect persisted up to 5 weeks postpartum. 42 This finding may be caused by an altered HPA set point in pregnancy, such that higher cortisol levels are needed to suppress ACTH secretion, also compounded by the increase in total serum cortisol level that occurs in pregnancy.…”