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Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder
Stuart Watson1, Peter Gallagher, James C Ritchie
1The Stanley Research Centre, University of Newcastle upon Tyne, The Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Summary
Hypothalamic-pituitary-adrenal (HPA) axis dysfunction, indicated by an enhanced cortisol response to the dexamethasone/corticotrophin-releasing hormone (dex/CRH) test, persists in bipolar disorder patients, even in remission. This suggests HPA axis abnormalities may be a trait marker for bipolar disorder.
Area of Science:
- Neuroendocrinology
- Psychiatry
- Bipolar Disorder Research
Background:
- Hypothalamic-pituitary-adrenal (HPA) axis function is reportedly abnormal in bipolar disorder.
- Previous studies utilized the dexamethasone suppression test (DST) and basal cortisol levels to assess HPA axis function.
Purpose of the Study:
- To investigate if HPA axis dysfunction persists in bipolar disorder patients who are in remission.
- To examine the cortisol response to the combined dexamethasone/corticotrophin-releasing hormone (dex/CRH) test in remitted and non-remitted bipolar disorder patients.
Main Methods:
- Examined salivary cortisol levels and plasma cortisol response to DST and dex/CRH test in 53 bipolar disorder patients (27 remitted) and 28 healthy controls.
- Measured serum dexamethasone levels to account for confounding effects.
Main Results:
- Bipolar disorder patients showed an enhanced cortisol response to the dex/CRH test compared to controls (P=0.001).
- No significant difference in dex/CRH test response was observed between remitted and non-remitted bipolar disorder patients.
- Findings remained significant after accounting for dexamethasone levels.
Conclusions:
- The dex/CRH test is abnormal in both remitted and non-remitted bipolar disorder patients.
- Abnormalities in HPA axis function, as measured by the dex/CRH test, may serve as a potential trait marker for bipolar disorder.
- This dysfunction could indicate a core pathophysiological process in bipolar disorder.