The Combined Dexamethasone-Suppression/CRH-Stimulation Test in Alcoholics During and After Acute Withdrawal

Abstract

Background: Chronic alcoholism is often accompanied by disturbances of the hypothalamic-pituitary-adrenal (HPA) system. Patients with alcoholism frequently show nonsuppression in the dexamethasone (Dex) suppression test and also a blunted increase of adrenocorticotropin (ACTH) after injection of corticotropin-releasing hormone (h CRH). However, the underlying mechanisms have not been fully elucidated. The combined Dex/CRH test (pretreatment with 1.5 mg dexamethasone at 2300 hr, injection of 100 μg h CRH at 1500 hr the next day) has been established as a more sensitive tool to investigate HPA system regulation in depressed patients. Methods: We studied the effect of the combined Dex/CRH test in 19 alcoholic inpatients (9 male, 10 female) during and after withdrawal along with 19 healthy controls. Results: Compared to normal controls, patients showed a severely dysregulated HPA system during withdrawal, with significantly elevated cortisol and ACTH response to h CRH after pretreatment with dexamethasone. After completed withdrawal, cortisol levels after injection of h CRH were almost normalized while ACTH values were partially lower in patients, compared to controls. Conclusions: We conclude that the HPA system is severely disturbed during alcohol withdrawal, possibly reflecting an exaggerated release of hypothalamic corticotropin and vasopressin.