CUSHING SYNDROME: ENDORPHIN/ACTH AND DEPRESSED MOOD

很大一部分原发性抑郁症患者 皮质醇分泌过多，昼夜节律周期变平， 用过夜地塞米松抑制血浆皮质醇浓度 test. 在这些患者中也发现ACTH水平升高。 最近，地塞米松抑制β-内啡肽的异常 也得到了证实。 库欣病是下丘脑-垂体-肾上腺皮质的经典疾病 轴激活，患者显示皮质醇，ACTH和 β-内啡肽水平 病人也有精神症状 以抑郁综合征为特征的模式。 我们建议研究ACTH异常与 β-内啡肽样免疫反应性（β-LPH/β-内啡肽）， 未经治疗的库欣综合征患者的抑郁情绪 了解这些物质可能参与 原发性抑郁症的病理生理学 我们的假设是抑郁情绪的程度不同 库欣综合征患者的经验可能与 血浆β-LPH/β-内啡肽升高程度的差异 和/或血浆β-LPH/β-内啡肽/ACTH比率。 我们计划通过确定以下因素之间的关联来研究这些关系： 抑郁情绪： a）在基底动脉中循环血浆β-LPH/β-内啡肽的水平， 国家; B）基础状态下的血浆β-LPH/β-内啡肽/ACTH比率; c）β-LPH/β-内啡肽/ACTH比率对刺激的反应， 甲吡酮阻断类固醇生成; d）血浆β-LPH/β-内啡肽/ACTH比率在 地塞米松抑制。

A significant proportion of patients with primary depressive disorder show cortisol hypersecretion, flattened circadian periodicity and failure to suppress plasma cortisol concentration with the overnight dexamethasone test. Increased ACTH levels have also been found in such patients. Recently, abnormalities in suppression of beta-endorphin by dexamethasone have also been demonstrated. Cushing's disease is the classic disease of hypothalamic-pituitary-adrenal axis activation, and patients show elevated cortisol, ACTH and beta-endorphin levels. The patients also have a psychiatric symptom pattern that is characterized by a depressive syndrome. We propose to study the association of abnormalities in ACTH and beta-endorphin-like immunoreactivity (Beta-LPH/Beta-endorphin) with depressed mood in patients with untreated Cushing's syndrome as an approach to understanding the possible involvement of these substances in the pathophysiology of primary depressive disorder. Our hypothesis is that the differences in degree of depressed mood experienced by patients with Cushing's syndrome may be associated with differences in the degree of elevation of plasma Beta-LPH/Beta-endorphin and/or plasma Beta-LPH/Beta-endorphin/ACTH ratios. We plan to study these relationships by determining the association of depressed mood with: a) the level of circulating plasma Beta-LPH/Beta-endorphin in the basal state; b) the plasma Beta-LPH/Beta-endorphin/ACTH ratio in the basal state; c) the response of the Beta-LPH/Beta-endorphin/ACTH ratio to stimulation by metyrapone block of steroidogenesis; d) the response of the plasma Beta-LPH/Beta-endorphin/ACTH ratio during suppression with dexamethasone.