Evaluation of Hypothalamo- Pituitary-Adrenal Axis Activity by Using Dexamethasone Suppression Test in Patients with Panic Disorder and Generalized Anxiety Disorder

Panik bozukluğu ve yaygın anksiyete bozukluğu olan hastalarda hipotalamo-pituiteradrenal eksen aktivitesinin deksametazon baskılama testi ile değerlendirilmesi Amaç: Bu çalışmanın amacı panik bozukluğu (PB) ve yaygın anksiyete bozukluğu (YAB) olan hastalarda hipotalamo-pituiter-adrenal (HPA) eksen aktivitesini inceleyerek, bu sistemin PB ve YAB'nin patofizyolojisindeki rolünü araştırmaktır. Yöntem: PB (n=24) ve YAB (n=21) olan hastalarda ve sağlıklı kontrollerde (n=20) bazal ve deksametazon baskılama testi (DST) uygulaması sonrasında kortizol ve dehidroepiandrosteron-sülfat (DHEA-S) değerleri ölçüldü. Bulgular: YAB grubunun bazal kortizol düzeyleri kontrol ve PB grubuna göre düşük bulundu. Ayrıca YAB grubunda deksametazonun kortizolu baskılaması kontrol ve PB grubuna göre düşük bulundu. PB ve YAB hastalarında bazal ve DST sonu DHEA-S düzeyleri kontrol grubuna benzer bulundu. Sonuç: YAB hastalarında bazal kortizol düzeyinin düşük olması ve DST'de kortizol baskılanmasının yetersiz oluşu bu hastalarda hem kortikotropin salgılatıcı hormon reseptörlerinde, hem de glukokortikoid reseptörlerinde bir aşağı ayarlama (down-regulation) olduğunu akla getirmektedir.

Panik bozukluğu ve yaygın anksiyete bozukluğu olan hastalarda hipotalamo-pituiteradrenal eksen aktivitesinin deksametazon baskılama testi ile değerlendirilmesi

Evaluation of hypothalamo-pituitary-adrenal axis activity by using dexamethasone suppression test in patients with panic disorder and generalized anxiety disorder Objective: The aim of this study was to investigate the role of hypothalamo-pituitary-adrenal (HPA) axis activity on the pathophysiology of anxiety disorders by examining the HPA axis activity in patients with panic disorder (PD) and generalized anxiety disorder (GAD). Method: Baseline and post dexamethasone suppression test (DST) serum concentrations of cortisol and dehydroepiandrosterone-sulfate (DHEA-S) were measured in patients with PD (n=24), GAD (n=21) and in healthy controls (n=20). Results: The baseline cortisol levels in GAD group were found lower than those of the patients with PD and healthy controls. Cortisol suppression by dexamethasone in GAD group was found to be lower than PD patients and healthy controls. Baseline and post-DST DHEA-S levels in the patients with PD and GAD were similar to those of the healthy controls. Conclusion: Lower cortisol levels and inadequate cortisol suppression with DST in GAD patients may suggest a downregulation in both corticotropin releasing hormone and glucocorticoid receptors in the central nervous system.

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