Clinical significance of psychoneuroendocrinology in psychiatry: focus on the thyroid and adrenal.
Clinical significance of psychoneuroendocrinology in psychiatry: focus on the thyroid and adrenal.
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发表时间：
1989
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通讯作者：
C. Nemeroff
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作者：
C. Nemeroff
在过去的20年里，大量的研究已经证明了情感障碍，特别是抑郁症患者的下丘脑-垂体-甲状腺（HPT）和下丘脑-垂体-肾上腺（HPA）轴的改变。虽然甲状腺激素（T3，T4）的血浆浓度在重度抑郁症患者中通常不变，但静脉注射促甲状腺激素释放激素（TRH）后，约25%的抑郁症患者血浆促甲状腺激素（TSH）反应减弱，约15%的抑郁症患者血浆促甲状腺激素（TSH）反应异常升高。数据支持的假设，TSH钝化可能是继发于中枢神经系统（CNS）的TRH分泌过多，而TSH反应增强可能是继发于亚临床甲状腺功能减退症与自身免疫性甲状腺炎。HPA轴在抑郁症患者中已经得到了相当多的研究，并且普遍认为50%至75%的重度抑郁症患者表现出HPA轴的过度活跃，其特征在于皮质醇血症、ACTH分泌过多和给予合成糖皮质激素地塞米松后血浆皮质醇浓度不受抑制。有证据表明，促肾上腺皮质激素释放因子（CRF）的分泌过多，至少在一定程度上，HPA轴活动过度，也许某些症状和体征的抑郁症。
Considerable research over the past 20 years has documented alterations in the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-adrenal (HPA) axes in patients with affective disorders, especially depression. Although plasma concentrations of thyroid hormones (T3, T4) are generally unaltered in patients with major depression, plasma thyroid stimulating hormone (TSH) responses after intravenous administration of thyrotropin-releasing hormone (TRH) are blunted in approximately 25% and abnormally elevated in approximately 15% of depressed patients. Data are presented supporting the hypothesis that TSH blunting may be secondary to central nervous system (CNS) hypersecretion of TRH, and that the enhanced TSH response may be secondary to subclinical hypothyroidism associated with autoimmune thyroiditis. The HPA axis has received considerable scrutiny in depressed patients and there is universal agreement that 50% to 75% of patients with major depression exhibit hyperactivity of the HPA axis characterized by hypercortisolemia, ACTH hypersecretion, and nonsuppression of plasma cortisol concentrations after administration of the synthetic glucocorticoid dexamethasone. Evidence is presented that hypersecretion of corticotropin-releasing factor (CRF) contributes, at least in part, to HPA axis hyperactivity and perhaps to certain of the signs and symptoms of major depression.