Higher Levels of Basal Serial CSF Cortisol in Combat Veterans With Posttraumatic Stress Disorder

• Published in: The American journal of psychiatry Vol. 162; no. 5; pp. 992 - 994
• Main Authors: Baker, Dewleen G., Ekhator, Nosa N., Kasckow, John W., Dashevsky, Boris, Horn, Paul S., Bednarik, Ludmila, Geracioti, Thomas D.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.05.2005; American Psychiatric Association
• Subjects: Adrenocorticotropic Hormone - blood; Adrenocorticotropic Hormone - cerebrospinal fluid; Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Brain; Catheterization, Peripheral; Catheters, Indwelling; Circadian Rhythm - physiology; Clinical trials; Combat Disorders - blood; Combat Disorders - cerebrospinal fluid; Combat Disorders - diagnosis; Corticotropin-Releasing Hormone - blood; Corticotropin-Releasing Hormone - cerebrospinal fluid; Hormones; Humans; Hydrocortisone - blood; Hydrocortisone - cerebrospinal fluid; Male; Medical sciences; Post traumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Spinal Puncture; Stress Disorders, Post-Traumatic - blood; Stress Disorders, Post-Traumatic - cerebrospinal fluid; Stress Disorders, Post-Traumatic - diagnosis; Subarachnoid Space; Veterans; Veterans - statistics & numerical data; Human; Corticosteroid; Posttraumatic syndrome; Steroid hormone; Adrenal hormone; Anxiety disorder; Posttraumatic stress disorder; Cerebrospinal fluid; Veteran; Hydrocortisone; Glucocorticoid; Stress
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.162.5.992

OBJECTIVE: Results of basal peripheral cortisol measures in posttraumatic stress disorder (PTSD) have been variable. The authors' goal was to measure CSF cortisol concentrations, which more accurately reflect brain glucocorticoid exposure, in subjects with or without PTSD. METHOD: CSF was withdrawn from a subarachnoid catheter and plasma from a venous catheter, both indwelling, over a 6-hour interval to determine hourly plasma ACTH and cortisol concentrations and hourly CSF cortisol levels in eight well-characterized combat veterans with PTSD and eight matched healthy volunteers. RESULTS: Mean CSF cortisol concentrations were significantly higher in the subjects with PTSD (3.18 ng ml, SD=0.33) than in the normal volunteers (2.33 ng ml, SD=0.50), largely due to higher CSF cortisol concentration nadirs. No group differences were observed in either plasma ACTH or peripheral (plasma or urinary free) cortisol. CSF corticotropin-releasing hormone and CSF cortisol concentrations were positively and significantly correlated. CONCLUSIONS: Despite normal peripheral cortisol indexes in the veterans with PTSD, their CNS exposure to cortisol was greater than that of normal comparison subjects.