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De regulatie van de hypothalamus-hypofyse-bijnier-as in de pathogenese van depressieve stoornissen

Published online by Cambridge University Press:  16 January 2019

J.G. Goekoop
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Samenvatting

De dexamethason-corticotrofin-releasing-hormoon (DEX-CRH)-test is de meest gevoelige test voor veranderingen in de regulatie van de hypothalamus-hypofyse-bijnier-as bij stemmingsstoornissen. Zowel in de premorbide toestand als tijdens de acute episoden van stemmingsstoornissen komt onder deze conditie een verhoogde cortisolreactie voor. Een irreversibele lage GAHA-concentratie kan aan dit regulatietekort een bijdrage leveren. Verhoogde noradrenerge en vasopressinerge activiteiten kunnen in de overgang naar hogere DEX-CRH-reacties tijdens de acute episode een rol spelen. De dexamethason-suppressie-test verschilt van de DEX-CRH-test door de afwezigheid van een externe CRH-belasting en ‘early escape’ in deze test is op specifieke wijze geassocieerd met het melancholische subsyndroom. Dit suggereert dat een endogeen verhoogde CRH-activiteit bij de overgang naar deze subcategorie is betrokken. Verhoogde CRH-activiteit is aangetoond en toenames van noradrenerge activiteit en 5-HT2a-receptoren en afnames van glucocorticoïd-receptor-functie, tryptofaan-concentratie en serotonine-afgifte kunnen een bijdrage leveren. De uiteindelijk resulterende hoge cortisol-concentraties lijken de ontwikkeling te kunnen bevorderen van een resttoestand met ‘early escape’ na herstel.

Summary

Summary

The dexamethasone-corticotrophin-releasing-honnone (DEX-CRH) test is the most sensitive lest to detect dysregulations of the hypothalamic-pituitary-adrenal axis. An enhanced cortisol release has been found in both the premorhid stage as in most acute episodes of mood disorders. An irreversibly low GABA concentration may be involved in the DEX-CRH response in the premorbid stage of a subgroup of unipolar and bipolar disorders. Increased noradrenaline and vasopressin concentrations may play a role in the change to higher DEX-CRH responses in acute episodes. The dexamethasone-suppression-test differs from the DEX-CRH-test by the absence of exogenous CRH, and early escape in this condition is specifically associated with the melancholic subtype. This means that an increased endogenous CRH-activity is involved in the change to this subcategory. Increased CRH-activity has been demonstrated and increased noradrenergic activity and upregulated 5-HT2a receptors as well as a decreased glucocorticoid receptor function, reduced tryptophan concentration and serotonin release may be involved. The eventually resulting increases in cortisol concentration seem to be involved in the development of a residual condition with early escape.

Keywords

Stemmingsstoornissenhypothalamus-hypofyse-bijnier-aspathogeneseMood disordershypothalamic-pituitary-adrenal axispathogenesis
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 10 , Issue 1 , March 1998 , pp. 1 - 6
Copyright
Copyright © Cambridge University Press 1998

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