Enhanced cortisol suppression in response to dexamethasone administration in traumatized veterans with and without posttraumatic stress disorder

• Published in: Psychoneuroendocrinology Vol. 32; no. 3; pp. 215 - 226
• Main Authors: de Kloet, C.S, Vermetten, E, Heijnen, C.J, Geuze, E, Lentjes, E.G.W.M, Westenberg, H.G.M
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-04-2007; Elsevier
• Subjects: Adaptation, Physiological; Adrenocorticotropic Hormone - metabolism; Adult; Adult and adolescent clinical studies; Analysis of Variance; Anxiety disorders. Neuroses; Area Under Curve; Behavioral psychophysiology; Biological and medical sciences; Carrier Proteins - metabolism; Case-Control Studies; Circadian Rhythm; Corticosteroid binding globulin; Corticosterone; Cortisol; Depressive Disorder, Major - complications; Depressive Disorder, Major - metabolism; Depressive Disorder, Major - physiopathology; Dexamethasone - pharmacology; Dexamethasone suppression test; Endocrinology & Metabolism; Fundamental and applied biological sciences. Psychology; Glucocorticoids - pharmacology; Hormones and behavior; HPA-axis; Humans; Hydrocortisone - blood; Hydrocortisone - metabolism; Male; Matched-Pair Analysis; Medical sciences; Middle Aged; Military Medicine; Post-traumatic stress disorder; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Psychopathology. Psychiatry; PTSD; Reference Values; Saliva; Saliva - metabolism; Statistics, Nonparametric; Stimulation, Chemical; Stress Disorders, Post-Traumatic - complications; Stress Disorders, Post-Traumatic - metabolism; Stress Disorders, Post-Traumatic - physiopathology; Stress, Psychological - metabolism; Stress, Psychological - physiopathology; Veterans - psychology; Wounds and Injuries - metabolism; Wounds and Injuries - physiopathology; PTSD; Cortisol; Corticosteroid binding globulin; Dexamethasone suppression test; Saliva; HPA-axis; Human; Corticosteroid; Dexamethasone; Posttraumatic syndrome; Hypothalamohypophysoadrenal axis; Steroid hormone; Anxiety disorder; Antiinflammatory agent; Posttraumatic stress disorder; Hydrocortisone; Glucocorticoid; Stress; Dexamethasone test; Adrenal hormone; Veteran
• ISSN: 0306-4530; 1873-3360
• DOI: 10.1016/j.psyneuen.2006.12.009

Summary Background While enhanced cortisol suppression in response to dexamethasone is one of the most consistent biological findings in posttraumatic stress disorder (PTSD), the relative contribution of trauma exposure to this finding remains unclear. Methods Assessment of diurnal salivary cortisol levels and 1600 h salivary cortisol before and after oral administration of 0.5 mg dexamethasone in veterans with PTSD, veterans without PTSD (trauma controls) and healthy controls. Assessment of 1600 h plasma cortisol, ACTH and corticotrophin binding globulin (CBG) in response to dexamethasone in PTSD patients and trauma controls. Results Both PTSD patients and trauma controls demonstrated significantly more salivary cortisol suppression compared to healthy controls. Salivary cortisol, plasma cortisol and ACTH suppression as well as CBG levels did not differ between PTSD patients and trauma controls. PTSD patients showed a reduced awakening cortisol response (ACR) compared to healthy controls that correlated significantly with PTSD symptoms. No significant differences were observed in ACR between PTSD patients and trauma controls. Conclusions These data suggest that enhanced cortisol suppression to dexamethasone is related to trauma exposure and not specifically to PTSD. The correlation between the ACR and PTSD severity suggests that a flattened ACR may be a result of clinical symptoms.