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The dex/CRH test--is it better than the DST?
Stuart Watson1, Peter Gallagher, Margaret S Smith
1School of Neurology, Neurobiology and Psychiatry, The Stanley Research Centre, University of Newcastle upon Tyne, Leazes Wing (Psychiatry), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. stuart.watson@ncl.ac.uk
Psychoneuroendocrinology
|May 17, 2006
Summary
The dexamethasone/corticotrophin-releasing-hormone (dex/CRH) test shows better diagnostic utility for mood disorders than the standard dexamethasone suppression test (DST). This suggests the dex/CRH test detects subtle hypothalamic-pituitary-adrenal axis disturbances missed by the DST.
Area of Science:
- Neuroendocrinology
- Psychiatry
- Clinical Diagnostics
Background:
- The dexamethasone suppression test (DST) is often abnormal in mood disorders, reflecting impaired glucocorticoid receptor negative feedback.
- Subtle hypothalamic-pituitary-adrenal (HPA) axis disturbances may exist in mood disorders, potentially undetectable by the DST.
Purpose of the Study:
- To investigate if the dexamethasone/corticotrophin-releasing-hormone (dex/CRH) test, hypothesized to be more sensitive, can identify HPA axis disturbances in mood disorder patients missed by the DST.
- To compare the diagnostic performance of the dex/CRH test versus the DST in mood disorder patients.
Main Methods:
- The study involved 82 patients diagnosed with mood disorders and 28 healthy controls.
- Both the DST and the dex/CRH test were administered to assess HPA axis function.
- Cortisol responses were measured, and Receiver Operating Characteristic (ROC) analysis was used to compare diagnostic utility.
Main Results:
- A significant correlation (r(s)=0.73, p<0.0005) was observed between cortisol responses in the DST and dex/CRH tests.
- ROC analysis indicated superior diagnostic performance for the dex/CRH test compared to the DST (p=0.031).
- The dex/CRH test demonstrated a sensitivity of 61.9% and specificity of 71.4%, while the DST showed 66.6% sensitivity and 47.6% specificity.
Conclusions:
- Both the DST and dex/CRH test appear to detect common underlying pathology related to HPA axis dysregulation in mood disorders.
- The dex/CRH test exhibits enhanced diagnostic utility, suggesting it is more effective at identifying subtle HPA axis disturbances in this patient population.