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

• 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
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/ajp.156.4.585

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 METHOD: CSF was withdrawn by means of a flexible, indwelling subarachnoid catheter over a 6-hour period, and hourly CSF concentrations of CRH were determined for 11 well-characterized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.