Urinary free cortisol and response to the dexamethasone suppression test in bulimia: A pilot study
Corresponding Author
Dr. James I. Hudson M. D.
Assistant Professor of Psychiatry
Harvard Medical School
Laboratories for Psychiatric Research, Mclean Hospital, Belmont, Massachusetts 02178Search for more papers by this authorDavid L. Katz M. D.
Clinical Fellow in Psychiatry
Harvard Medical School
Search for more papers by this authorHarrison G. Pope Jr. M. D.
Associate Professor of Psychiatry
Harvard Medical School
Search for more papers by this authorMargo S. Hudson M. D.
Clinical Instructor in Medicine, Boston University School of Medicine
Harvard Medical School
Search for more papers by this authorGeorge T. Griffing M. D.
Assistant Professor of Medicine
Harvard Medical School
Search for more papers by this authorJames C. Melby M. D.
Professor of Medicine
Harvard Medical School
Search for more papers by this authorCorresponding Author
Dr. James I. Hudson M. D.
Assistant Professor of Psychiatry
Harvard Medical School
Laboratories for Psychiatric Research, Mclean Hospital, Belmont, Massachusetts 02178Search for more papers by this authorDavid L. Katz M. D.
Clinical Fellow in Psychiatry
Harvard Medical School
Search for more papers by this authorHarrison G. Pope Jr. M. D.
Associate Professor of Psychiatry
Harvard Medical School
Search for more papers by this authorMargo S. Hudson M. D.
Clinical Instructor in Medicine, Boston University School of Medicine
Harvard Medical School
Search for more papers by this authorGeorge T. Griffing M. D.
Assistant Professor of Medicine
Harvard Medical School
Search for more papers by this authorJames C. Melby M. D.
Professor of Medicine
Harvard Medical School
Search for more papers by this authorAbstract
Previous studies have reported that patients with bulimia often display nonsuppressed responses to the dexamethasone suppression test (DST), suggesting that bulimia may be associated with hypercortisolism. To further evaluate the hypothalamic-pituitary-adrenal axis in bulimia, 24-hour urinary free cortisol (UFC) levels and response to the 1 mg dexamethasone suppression test (DST) were assessed in 7 normal-weight women with bulimia by DSM-III criteria. All subjects displayed normal UFC levels and nonsuppressed responses to the DST.
References
- Akiskal, H. S. Lemmi, H., Yerevanruan, B., King, D., & Belluomiru, J. (1982) The utility of the REM latency test in psychiatric diagnosis: A study of 81 depressed outpatients. Pshychiatry Research, 7, 101–110.
- American Psychiatric Association. (1980) Diagnostic and statistical manual of mental disorders ( 3rd ed.). Washington D. C.: American Psychiatric Association.
- Burch, W. M., (1982) Urinary free-cortisol determination. Journal of the American Medical Association, 247, 2002–2004.
- Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., James, N. M., Kronfol, Z., Lohr, N., Steiner, M., de Vigne, J. P., & Young, E. (1981) A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clirucal utility. Archives of General Psychiatry, 38, 15–22.
- Cashman, M. A., Coble, P., McCann, B. S., Taska, L., Reynolds, C. F., & Kupfer, D. J. (1986) Sleep markers for major depressive disorder in adolescent patients. Sleep Research, 15, Abs. 91.
- Edelstein, C. K., Roy-Byrne, P., Fawzy, F. I., & Dornfield, L. (1983) Effects of weight loss on the dexamethasone suppression test. American Journal of Psychiatry, 140, 338–341.
- Fichter, M. M., Pirke, K. M., & Holsboer, F. (1986) Weight loss causes neuroendocrine disturbanes: Experimental study in healthy starving subjects. Psychiatry Research, 17, 61–72.
- Friedman, E. J., Stolar, M., Gerner, R., & Kramer, M. (1986) Neuroendocrine aspects of bulimia. Presented at the Second International Conference on Eating Disorders, March, 1986, New York.
- Gillin, J. C., Duncan, W., Pettigrew, K. D., Frankel, B. L., & Snyder, F. (1979) Successful separation for depressed, normal, and insomniac subjects by EEG sleep data. Archives of General Psychiatry, 36, 85–90.
- Gold, P. W., Gwirtsman, H., Avgerinos, P. C., Nieman, L. K., Gallucci, W. R., Kaye, W., Jimerson, D., Ebert, M., Rittmaster, R., Loriaux, D. L., & Chrousos, G. P. (1986a). Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa: Pathophysiologic mechanisms in underweight and weight-corrected patients. New England Journal of Medicine, 314, 1335–1342.
- Gold, P. W., Loriaux, D. L., Roy, A., Kling, M. A., Calabrese, J. R., Kellner, C. H., Nieman, L. K., Post, R. M., Pickar, D., Gallucci, W. T., Avgerinos, P., Paul, S., Oldfied, E. H., Cutler, G. B., Jr., & Chrousos, G. P. (1986b). Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing's disease: Pathophysiologic and diagnostic implication. New England Journal of Medicine, 314, 1329–1335.
- Griffing, G. T., & Melby, J. C. (1983) In V. B. Mahesh, and R. B. Greenblatt, (Eds.), Hirsuitism and Virilism. Boston: John Wright, pp. 63–85.
- Gwirtsman, H. E., Roy-Byrne, P., Yager, J., & Gerner, R. H. (1983) Neuroendocrine abnormalities in bulimia. American Journal of Psychiatry, 140, 559–563.
- Hamilton, M. (1967) Development of rating scale for primary depressive illness. British Journal of the Society of Clinical Psychology, 6, 278–296.
- Hawkins, D. R., Taub, J. M., & Van de Castle, R. L. (1985) Extended sleep (hypersomnia) in young patients. American Journal of Psychiatry, 142, 905–910.
- Hudson, J. I., & Hudson, M. S. (1984) Endocrine dysfunction in anorexia nervosa and bulimia: Comparison with abnormalities in other psychiatric disorders and disturbances due to metabolic factors. Psychiatric Developments, 4, 237–272.
- Hudson, J. I., & Pope, H. G., Jr. (in press). Depression and eating disorders. In O. G. Cameron (Ed.), Presentations of Depression. New York: John Wiley & Sons.
- Hudson, J. I., Pope, H. G., Jr., Jonas, J. M., Stakes, J. W., Grochocinski, V., Lipinski, J. F., & Kupfer, D. J. Biological Psychiatry (in press). Sleep EEG in bulimia.
- Hudson, J. I., Pope, H. G., Jr., Jonas, J. M., & Yurgelun-Todd, D. (1983) Hypothalamicpituitary-adrenal axis hyperactivity in bulimia. Psychiatry Research, 8, 111–118.
- Hughes, P. L., Wells, L. A., & Cunningham, C. J. (1984) A controlled trial using desipramine for bulimia. Presented at the American Psychiatric Association Annual Meeting, Los Angeles, May, 1984).
- Jaffe, K., Barnshaw, D., & Kennedy, M. E. (1983) The dexamethasone suppression test in outpatients with and without melancholia. American Journal of Psychiatry, 140, 492–493.
- Kaplan, A. S., Garfinkel, P. E., Warsh, J. J., & Brown, G. M. (1986) The DST and TRH stimulation test in normal weight bulimia. Presented at the Second International Conference on Eating Disorders, New York, March, 1986).
- Kupfer, D. J., Spiker, D. G., Coble, P. A., McPartland, R. J., & Ulrich, R. (1978) The application of EEG sleep for the differential diagnosis of affective disorders. American Journal of Psychiatry, 135, 69–74.
- Liebowitz, M. R., Quitkin, F. M., Stewart, J. W., McGrath, P. J., Harrison, W., Rabkin, J., Tricamo, E., Markowitz, J. S., & Klein, D. F. (1984) Phenelzine v imipramine in atypical depression: A preliminary report. Archives of General Psychiatry, 41, 669–677.
- Lindy, D. C., Walsh, B. T., Roose, S. P., Gladis, M., & Glassman, A. H. (1985) The dexamethasone suppression test in bulimia. American Journal of Psychiatry, 142, 1375–1376.
- Mitchell, J. E., Pyle, R. L., Hatsukami, D., & Boutzcoff, L. I. (1985) The dexamethasone suppresion test in patients with bulimia. Journal of Clinical Psychiatry, 45, 508–511.
- Musisi, S., & Garfinkel, P. E. (1985) Comparative dexamethasone suppression test measurements in bulimia, depression and normal controls. Canadian Journal of Psychiatry, 30, 190–194.
- Perez, E., Blouin, J., Barlow, J., & Bloin, A. (1986) The dexamethasone suppression test in bulimia. Presented at the Second International Conference on Eating Disorders, April, 1986.
- Robins, L. N., Helzer, J. I., Croughan, J., Williams, J., & Spitzer, R. L. (1980) NIMH Diagnostic Interview Schedule 2nd ed. Rockville, Md.: National Institute of Mental Health.
- Ruder, H. J., Guy, R. L., & Lipsett, M. B.. (1972) A radioimmunoassay for cortisol in plasma and urine. Journal of Clinical Endocrinology and Metabolism, 35, 219–224.
- Rush, A. J., Giles, D. E., Roffwarg, H. P., & Parker, C. R. (1982) Sleep EEG and dexamethasone suppression test findings in outpatients with unipolar major depressive disorder. Biological Psychiatry, 17, 327–341.
- Society of Actuaries and Association of Life Insurance Medical Directors of America (1980) 1979 Build Study. Chicago: Author.
- Stokes, P. E., Stoll, P. M., Koslow, S. H., Mass, J. W., Davis, J. M., Swann, A. C., & Robins, E. (1984) Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: A multicenter study. Archives of General Psychiatry, 41, 257–267.
- Taub, J. M., Hawkins, D. R., & Van de Castle, R. L. (1978) Electrographic analysis of the sleep cycle in young depressed patients. Biological Psychology, 7, 203–214.
- Walsh, B. T., Rouse, S. P., Lindy, D. C., Gladis, M. A., & Glassman, A. H. (1986) Adrenal activity in normal weight bulimia. Presented at the American Psychiatric Association Annual Meeting, Washington, D. C., May 12, 1986.
- Winokur, A., Amsterdam, J., Caroff, S. Snyder, P. J., & Brunswick, D. (1982) Variability of hormonal responses to a series of neuroendocrine challenges in depressed patients. American Journal of Psychiatry, 139, 39–44.