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Related Experiment Videos

Dexamethasone suppression test abnormalities in multiple sclerosis: relation to ACTH therapy.

A T Reder, M T Lowy, H Y Meltzer

    Neurology
    |May 1, 1987
    PubMed
    Summary

    The overnight dexamethasone suppression test (DST) revealed abnormal cortisol levels in 50% of multiple sclerosis (MS) patients, unlike healthy controls. This neuroendocrine test may indicate glucocorticoid sensitivity in MS.

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    Area of Science:

    • Neuroendocrinology
    • Clinical Medicine
    • Psychiatry

    Background:

    • The dexamethasone suppression test (DST) is a neuroendocrine test used to assess hypothalamic-pituitary-adrenal (HPA) axis function.
    • Abnormalities in the DST have been observed in various psychiatric and medical conditions, suggesting dysregulation of the HPA axis.

    Purpose of the Study:

    • To investigate the utility of the 1-mg overnight dexamethasone suppression test (DST) in patients diagnosed with multiple sclerosis (MS).
    • To explore the relationship between DST results, dexamethasone bioavailability, and clinical response to adrenocorticotropic hormone (ACTH) therapy in MS patients.

    Main Methods:

    • Administered a 1-mg overnight dexamethasone suppression test (DST) to patients with MS.
    • Measured serum cortisol levels post-DST and compared them to established cutoffs (5.0 micrograms/dl).

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  • Assessed serum dexamethasone levels and clinical response to ACTH therapy in relation to DST results.

    • Main Results:

    • Approximately 50% of MS patients failed to suppress serum cortisol below 5.0 micrograms/dl, a rate similar to patients with major depression but significantly higher than normal controls (11%).
    • MS patients who were 'nonsuppressors' on the DST did not exhibit greater depressive symptoms than 'suppressors'.
    • Nonsuppressors had lower serum dexamethasone levels compared to suppressors, suggesting potential issues with dexamethasone bioavailability. Suppressors showed clinical improvement after ACTH therapy, while nonsuppressors did not, with dexamethasone levels correlating positively with treatment response.

    Conclusions:

    • The 1-mg overnight DST may serve as a valuable neuroendocrine tool for assessing glucocorticoid sensitivity in individuals with MS.
    • Findings suggest potential HPA axis dysregulation and altered dexamethasone pharmacokinetics in MS patients, impacting treatment outcomes.