Posted by katekite on July 2, 2002, at 22:32:32
In reply to Re: Cortisol connection - I'm confused, posted by Emme on July 2, 2002, at 16:19:14
great question -- i spent like 2 days looking this up.
Yes people with depression are often borderline high on the 24 hour urine free cortisol (UFC). Or high for their age and physical health but still in the normal range. They set the normal range widely with this. In Cushing's syndrome, 10% of the time someone who truly has Cushing's will actually test in the normal range. If one samples salivary cortisol or blood cortisol its even worse mixup. If someone tests normal but shows many or serious physical symptoms they should test again later.
If one has physical symptoms but not a high UFC or has a mildly high UFC but no symptoms, and lab tests say its not Cushing's, then it's called 'pseudo-Cushing's'. (an unfortunate name because people don't necessarily suffer less). The main tests are a low-dose-dexamethasone-suppression test (LDDST) and a CRF stimulation test. (I think)
There are many theories on how to differentiate based on physical symptoms, but nothing is reliable. Many people look like they have Cushing's but few do. Most people with high urine free cortisol do have Cushing's. The lab tests are excellent in that they really almost always can differentiate between Cushing's and the high cortisol of depression/anxiety/etc.
So, if you did test to have a high UFC then a couple further tests would be done to rule in or out Cushing's. A regular doctor or psychiatrist would order the urine free cortisol, but if it came back high one would most likely see an endocrinologist to figure it's cause out.
The other things besides Cushing's syndrome that cause urinary free cortisol to be high include critical or serious illness, such as hiv or Alzheimers. A few cases reported of lyme disease or other weird ones.
The more common thing with cortisol in depression is something called 'non-suppression' meaning the cues that normally shut off cortisol release are screwed up, and when the depression lifts all that returns to normal. This is often referred to as 'high cortisol' , incorrectly. Also some people with depression lose their normal daily rhythm of cortisol, so it would be high at times when it should be low. This also would return to normal when the depression lifts.
This is not to say that a subgroup of people with depression etc don't have truly high cortisol (UFC). These are often people who don't respond to any regular antidepressants. These people would go through the tests and be determined to have 'pseudo-Cushing's' and despite it sounding like a fake problem (which its not) anti-cortisol medication would still likely help them (just no tumor to remove).
The medications to treat consistently high cortisol include: cyproheptadine, bromocriptine, ketoconazole, and the new kid on the block, RU486. Also when the CRF antagonists come out in a few years they will probably work too. The downsides of these treatments, and the reason to check urine cortisol before asking for any of them, is that they don't help people with normal cortisol and also can have significant side effects (liver damage, for example for ketoconazole).
poster:katekite
thread:111175
URL: http://www.dr-bob.org/babble/20020628/msgs/111248.html