Serial CSF Corticotropin-Releasing Hormone Levels and Adrenocortical Activity in Combat Veterans With Posttraumatic Stress Disorder

OBJECTIVE: The authors sought to carefully test, by using a technique of continuous CSF sampling, the hypothesis that basal elevations in CSF corticotropin-releasing hormone (CRH) concentrations exist in patients with posttraumatic stress disorder (PTSD). They also sought to assess the relationship...

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Published in:	The American journal of psychiatry Vol. 156; no. 4; pp. 585 - 588
Main Authors:	Baker, Dewleen G., West, Scott A., Nicholson, Wendall E., Ekhator, Nosa N., Kasckow, John W., Hill, Kelly K., Bruce, Ann B., Orth, David N., Geracioti, Thomas D.
Format:	Journal Article
Language:	English
Published:	Washington, DC American Psychiatric Publishing 01-04-1999 American Psychiatric Association
Subjects:	Adrenal Cortex - secretion Adult Adult and adolescent clinical studies American people Analysis of Variance Anxiety disorders. Neuroses Biological and medical sciences Brain Catheters, Indwelling Cerebrospinal Fluid - chemistry Circadian Rhythm - physiology Combat Disorders - cerebrospinal fluid Combat Disorders - diagnosis Combat related posttraumatic stress disorder Corticotropin-Releasing Hormone - cerebrospinal fluid Hormones Humans Hydrocortisone - urine Levels Male Medical research Medical sciences Middle Aged Post traumatic stress disorder Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Spinal Puncture - methods Subarachnoid Space Veterans Human Posttraumatic syndrome Steroid hormone Peptide hormone Anxiety disorder Corticotropin releasing factor Cerebrospinal fluid Hydrocortisone Glucocorticoid Stress Hypothalamic hormone Symptomatology Adrenal hormone Hormone releasing factor Veteran
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Summary:	OBJECTIVE: The authors sought to carefully test, by using a technique of continuous CSF sampling, the hypothesis that basal elevations in CSF corticotropin-releasing hormone (CRH) concentrations exist in patients with posttraumatic stress disorder (PTSD). They also sought to assess the relationship among PTSD symptoms, adrenocortical activity, and CSF CRH levels. METHOD: CSF was withdrawn by means of a flexible, indwelling subarachnoid catheter over a 6-hour period, and hourly CSF concentrations of CRH were determined for 11 well-characterized combat veterans with PTSD and 12 matched normal volunteers. Twenty-four-hour urinary-free cortisol excretion was also determined. PTSD and depressive symptoms were correlated with the neuroendocrine data. RESULTS: Mean CSF CRH levels were significantly greater in PTSD patients than in normal subjects (55.2 [SD=16.4] versus 42.3 pg ml [SD=15.6]). No correlation was found between CSF CRH concentrations and PTSD symptoms. While there was no significant difference between groups in 24-hour urinary-free cortisol excretion, the correlation between 24-hour urinary-free cortisol excretion and PTSD symptoms was negative and significant. CONCLUSIONS: By using a serial CSF sampling technique, the authors found high basal CSF CRH concentrations and normal 24-hour urinary-free cortisol excretion in combat veterans with PTSD, a combination that appears to be unique among psychiatric conditions studied to date.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-953X 1535-7228
DOI:	10.1176/ajp.156.4.585