Cortisol response to ovine corticotropin-releasing hormone in a model of pregnancy and parturition in euthymic women with and without a history of postpartum depression
Cortisol response to ovine corticotropin-releasing hormone in a model of pregnancy and parturition in euthymic women with and without a history of postpartum depression
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DOI：
10.1210/jc.2004-1388
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发表时间：
2005-02-01
影响因子：
5.8
通讯作者：
Cizza, G
中科院分区：
文献类型：
--
作者：
Bloch, M;Rubinow, DR;Cizza, G
与非抑郁症妇女相比，抑郁症妇女和产后忧郁症妇女的下丘脑-垂体-肾上腺轴异常已有报道。我们通过建立妊娠和产后内分泌模型，研究了性腺类固醇激素对有(n=5)和无(n=7)产后抑郁症(PPD)既往病史妇女的激素反应的影响。绵羊促肾上腺皮质激素释放激素(1ug/kg)刺激试验在基础卵泡期、激素回补期间(醋酸亮丙瑞林加超生理剂量的雌二醇孕酮模拟妊娠)和急停激素替代(模拟产褥期)后进行。观察到显著的时间阶段(P<；0.005)和诊断阶段(P<；0.05)的交互作用，反映了皮质醇在表面生理阶段的刺激增加，特别是在有产后抑郁病史的受试者。皮质醇曲线下面积在诊断效果上也显示出明显的阶段性(P<；0.05)。在生殖上期尿游离皮质醇(P<；0.001)、曲线下皮质醇面积(P<；005)和血浆皮质醇结合球蛋白(P<；0.05)也显著增加。我们的数据显示，在人类和动物中，性腺上皮质醇水平增强了垂体-肾上腺轴的活性，而且，有产后抑郁症病史的女性对性腺类固醇的敏感性增强。
Hypothalamic-pituitary-adrenal axis abnormalities have been reported in depressed women and those with postpartum blues, compared with nondepressed women.We investigated the effect of gonadal steroids on the hormonal response to ovine CRH in women with (n = 5) and without (n = 7) a past history of postpartum depression (PPD) by creating an endocrine model of pregnancy and the postpartum. Ovine CRH (1 mug/kg) stimulation tests were performed in the baseline follicular phase, during hormone add-back (leuprolide acetate plus supraphysiologic doses of estradiol and progesterone-mimicking pregnancy), and after precipitous withdrawal of hormone replacement (mimicking the puerperium).Significant phase by time (P < 0.005) and phase by diagnosis (P < 0.05) interactions were observed, reflecting increased stimulated cortisol during the supraphysiologic phase, particularly in subjects with a history of PPD. Cortisol area under the curve also showed a significant phase by diagnosis effect (P < 0.05). Significant increases during the supraphysiologic phase were also seen for urinary free cortisol (P < 0.05), cortisol area under the curve (P < 0.001), and plasma corticosteroid-binding globulin (P < 0.05).Our data show that in humans, as in animals, supraphysiologic gonadal steroid levels enhance pituitary-adrenal axis activity, and, further, that women with a history of PPD have an enhanced sensitivity of the pituitary-adrenal axis to gonadal steroids.