Endokrinologische Typisierang depressiver Patienten durch den Dexamethason-Suppressionstest

  • F. Holsboer
Conference paper

Zusammenfassung

Die Hypophysen-Nebennierenrinden-Achse ist das bis heute in der Psychiatrie am intensivsten untersuchte endokrine System [45, 53]. Bei einer Vielzahl psychiatrisch erkrankter Patienten findet sich erhöhte Kortisolsekretion und eine Nivellierung der physiologischen zirkadianen Rhythmik. Vor allem bei depressiven Patienten beobachteten Sachar et al. [47] deutlich erhöhte Nebennierenrindenaktivität, die sich nach klinischer Remission wieder normalisierte. Bei Gesunden kann nach oraler Gabe des synthetischen Glukokortikoids Dexamethason die endogene Kortisolsekretion für die Dauer von etwa 24 h unterdrückt werden. Bei etwa der Hälfte der Patienten mit erhöhter Hypophysen-Nebennierenrinden-Aktivität reicht die üblicherweise angewandte Testdosis von 1–2 mg Dexamethason nicht aus, um eine 24stündige Unterdrückung der Kortisol-Plasma-Konzentration unterhalb eines willkürlich festgelegten Grenzwertes von 40–60 ng/ml aufrechtzuerhalten. Diese Nichtsupprimierbarkeit von Kortisol durch Dexamethason bei psychiatrisch erkrankten Patienten wurde v. a. von Carroll et al. [6,9] hinsichtlich seiner Spezifität für die Diagnose endogene Depression ausgearbeitet. Die meisten der heute vorliegenden Arbeiten replizierten die hohe diagnostische Spezifität des DST [5]. In den letzten Jahren sind allerdings zahlreiche Befunde bekannt geworden, die ältere Berichte über die nur mäßige diagnostische Zuverlässigkeit des DST [3,27,48, 50] bei Patienten mit einem depressiven Syndrom bestätigten.

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© Springer-Verlag Berlin Heidelberg 1984

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  • F. Holsboer

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