Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-28T03:52:33.592Z Has data issue: false hasContentIssue false

The DST and TRH Test in Bulimia Nervosa

Published online by Cambridge University Press:  02 January 2018

Allan S. Kaplan*
Affiliation:
Eating Disorder Centre, Toronto General Hospital; University of Toronto
Paul E. Garfinkel
Affiliation:
Department of Psychiatry, Toronto General Hospital; University of Toronto
Gregory M. Brown
Affiliation:
McMaster University, Hamilton, Canada
*
CW 1-311, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada

Abstract

Abnormal neuroendocrine responses have been found in depression and eating disorders. It remains unclear whether these reflect an underlying shared biology or epiphenomena. To evaluate this further, we conducted the 1 mg DST and the TSH response to 500 μg i.v. TRH in normal-weight bulimics and controls. Bulimics (n = 18) demonstrated significantly more DST non-suppression (45%) than controls (18%; n = 20). In the bulimic group, non-suppressors were significantly thinner than suppressors, but did not differ from them on any measure of depression. Bulimics (n = 19) and controls (n = 12) responded similarly without blunting on the TSH response to TRH. These data suggest that DST non-suppression may be related to non-specific variables such as weight. Bulimics do not demonstrate TSH blunting as found in some depressed patients. These tests do not support evidence for a biological link between these disorders.

Type
Papers
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American, Psychiatric Association. (1987) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. Washington DC: American Psychiatric Association.Google Scholar
Andersen, M. S., Bowers, C. J., Kastin, A. J., Schalch, D. S., Schally, A. V., Snyder, P. J., Utiger, R. D., Wilber, J. F. & Wise, A. J. (1971) Synthetic TRH, a potent stimulator or thyrotropin secretion in man. New England Journal of Medicine, 285, 12791283.Google Scholar
Beck, A. T., Ward, C. H. & Mendelson, M. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.Google Scholar
Berger, M., Pirke, K. M. & Doerr, P. (1983) Influence of weight loss on the DST. Archives of General Psychiatry, 40, 585586.CrossRefGoogle Scholar
Berger, M., Pirke, K. M., Krieg, J. C. & vonZerssen, D. (1985) The effect of weight loss and inappropriate plasma dexamethasone levels on the dexamethasone suppression test. Psychiatry Research, 15, 351.Google Scholar
Brown, G. M., Garfinkel, P. E., Jeuniewic, N., Moldofsky, H. & Stancer, H. C. (1977) Endocrine profiles in anorexia nervosa. In Anorexia Nervosa (ed. Vigersky, R.). New York: Raven Press.Google Scholar
Brown, G. M., Seggie, J. A., Chambers, J. W. & Ettigi, P. K. (1978) Psychoendocrinology and growth hormone: a review. Psychoneuroendocrinology, 3, 131153.Google Scholar
Caroll, B. S. (1982) The dexamethasone suppression test for melancholia. British Journal of Psychiatry, 140, 292304.Google Scholar
Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., James, N., Kronfol, Z., Lohr, N., Steiner, M., deVigne, J. P. & Young, E. (1981) A specific laboratory test for the diagnosis of melancholia: standardization, validation and clinical utility. Archives of General Psychiatry, 38, 1522.Google Scholar
Casper, R. C., Eckert, E. D., Halmi, K. A., Goldberg, S. C. & Davis, J. M. (1980) Bulimia: its incidence and clinical significance in patients with anorexia nervosa. Archives of General Psychiatry, 37, 10301035.Google Scholar
Castro, P., Lemaire, M., Toscano-Aguiler, M. & Herchuelz, P. (1983) Abnormal DST results in patients with chronic schizophrenia. American Journal of Psychiatry, 140, 1261.Google Scholar
Cooper, P. J. & Fairburn, C. G. (1983) Binge eating and self-induced vomiting in the community: a preliminary study. British Journal of Psychiatry, 142, 139144.Google Scholar
Department of National Health and Welfare (1954) Canadian Average Weights for Height, Age and Sex. Ottowa: Nutrition Division of the Department of National Health and Welfare.Google Scholar
Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H. & Covi, L. (1974) The Hopkins Symptom Checklist (HSCL): a self report symptom inventory. Behavioral Science, 19, 115.Google Scholar
Dewan, M., Perdorangi, A., Boucher, M., Levy, B. & Major, L. (1982) Abnormal dexamethasone suppression test results in chronic schizophrenia. American Journal of Psychiatry, 139, 15011503.Google Scholar
Doerr, P., Fichter, M. M., Pirke, K. M. & Lund, R. (1980) Relationship between weight gain and hypothalamic pituitary adrenal function in patients with anorexia nervosa. Journal of Steroid Biochemistry, 13, 523537.Google Scholar
Dubois, A., Gross, H. A., Ebert, M. H. & Castell, D. O. (1979) Altered gastric emptying and secretion in primary anorexia nervosa. Gastroenterology, 77, 309323.Google Scholar
Edelstein, C. K., Roy-Byrne, P., Fawcy, F. I. & Dornfeld, L. (1983) Effects of weight loss on the dexamethasone suppression test. American Journal of Psychiatry, 140, 338341.Google Scholar
Ehrensing, R. H., Kastin, A. J., Schalch, D. S., Friesen, H. G., Vargas, J. R. & Schally, A. V. (1974) Affective state and thyrotropin releasing hormone in depressed patients. American Journal of Psychiatry, 131, 714718.Google Scholar
Fichter, M. M., Pirke, K. M. & Holsboor, E. (1986) Weight loss causes neuroendocrine disturbances: experimental study in healthy starving subjects. Psychiatry Research, 17, 6172.Google Scholar
Garbutt, J. L., Loosen, P. T., Tipermas, A. & Prange, A. J. (1983) The TRH test in patients with borderline personality. Psychiatry Research, 9, 107113.Google Scholar
Garfinkel, P. E., Moldofsky, H. & Garner, D. M. (1980) The heterogeneity of anorexia nervosa: bulimia as a distinct subgroup. Archives of General Psychiatry, 37, 10361040.Google Scholar
Garfinkel, P. E., & Moldofsky, H. (1982) Anorexia Nervosa: a Multidimensional Perspective. New York: Brunner Mazel.Google Scholar
Gerner, R. H. & Gwirtsman, H. E. (1981) Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa. American Journal of Psychiatry, 138, 650653.Google Scholar
Gold, M. S., Pottash, A. L., Sweeney, D. R., Martin, D. M. & Davies, R. K. (1980) Further evidence of hypothalamic pituitary dysfunction in anorexia nervosa. American Journal of Psychiatry, 137, 101102.Google ScholarPubMed
Gold, M. S., Pottash, A. L., Extein, I., Martin, D. M., Howard, E., Mueller, F. A. & Sweeney, D. R. (1981) The TRH test in the diagnosis of major and minor depression. Psychoneuroendocrinology, 6, 159169.Google Scholar
Gwirtsman, H. E., Roy-Byrne, P., Yager, J. & Gerner, R. G. (1983) Neuroendocrine abnormalities in bulimia. American Journal of Psychiatry, 140, 559563.Google Scholar
Gwirtsman, H. E., Roy-Byrne, P., Lerner, L. & Yager, J. (1984) Bulimia in men: report of three cases with neuroendocrine findings. Journal of Clinical Psychiatry, 45, 7881.Google Scholar
Holt, S., Ford, M. J., Grant, S. & Heading, R. C. (1981) Abnormal gastric emptying in primary anorexia nervosa. British Journal of Psychiatry, 139, 550552.Google Scholar
Hudson, J. I., Laffer, P. S. & Pope, A. G. jr (1982) Bulimia related to affective disorder by family history and response to dexamethasone suppression test. American Journal of Psychiatry, 139, 685687.Google ScholarPubMed
Hudson, J. I., Pope, H. G. & Jonas, J. M. (1983a) Phenomenologic relationship of eating disorders to major affective disorder. Psychiatry Research, 9, 345359.Google Scholar
Hudson, J. I., Pope, H. G., Jonas, J. M., Laffer, P. S., Hudson, M. S. & Melby, J. C. (1983b) Hypothalamic pituitary adrenal axis hyperactivity in bulimia. Psychiatry Research, 8, 111117.Google Scholar
Hudson, J. I., Pope, H. G., Jonas, J. M., & Yurgelun-Todd, D. (1983c) Family history study of anorexia nervosa and bulimia. British Journal of Psychiatry, 142, 133138.Google Scholar
Insil, T. & Goodwin, F. K. (1983) The dexamethasone suppression test: promises and problems of diagnostic laboratory tests in psychiatry. Hospital and Community Psychiatry, 34, 11311138.Google Scholar
Isaacs, A. J., Leslie, R. D. G., Gomez, J. & Bayliss, R. (1980) The effect of weight gain on gonadotropins and prolactin in anorexia nervosa. Acta Endocrinology, 94, 145150.Google Scholar
Johnson, C. J., Lewis, C. & Hagman, J. (1984) The syndrome of bulimia. Psychiatric Clinics of North America, 7, 247273.Google Scholar
Katzman, M. A., Wolchick, S. A. & Braver, S. L. (1984) The prevalence of frequent binge eating and bulimia in a non-clinical college sample. International Journal of Eating Disorders, 3, 5361.Google Scholar
Kiriike, N., Nishiwaki, S., Izumiya, Y. & Kawakita, Y. (1986) Dexamethasone suppression test in bulimia. Biological Psychiatry, 21, 328332.Google Scholar
Kiriike, N., Nishiwaki, S., Izumiya, Y., Maeda, Y. & Kawakita, Y. (1987) Thyrotropin, prolactin and growth hormone responses to thyrotropin-releasing hormone in anorexia nervosa and bulimia. Biological Psychiatry, 22, 167176.Google Scholar
Kirschbaum, W. R. (1951) Excessive hunger as a symptom of cerebral origin. Journal of Nervous and Mental Disease, 113, 95114.Google Scholar
Levy, A., Dixon, K. N. & Malarkey, W. (1988) Pituitary response to TRH in bulimia. Biological Psychiatry, 23, 476484.CrossRefGoogle ScholarPubMed
Loosen, P. T. & Prange, A. J. (1979) TRH in alcoholic men: endocrine responses. Psychosomatic Medicine, 41, 584585.Google Scholar
Loosen, P. T. & Prange, A. J. (1980) TRH: a useful tool for psychoneuroendocrine investigation. Psychoneuroendocrinology, 5, 6380.CrossRefGoogle ScholarPubMed
Loosen, P. T. & Prange, A. J. (1962) Serum thyrotropin response to thyrotropin releasing hormone in psychiatric patients: a review. American Journal of Psychiatry, 139, 405416.Google Scholar
Maeda, K., Kato, Y., Ohgo, S., Chihara, K., Hoshimoto, Y., Yamugachi, N., Juromaro, S. & Imura, H. (1975) Growth hormone and prolactin release after injection of thyrotropin releasing hormone in patients with depression. Journal of Clinical Endocrinology and Metabolism, 40, 501505.Google Scholar
Maeda, K., Kato, Y. & Yamaguchi, N. (1976) Growth hormone release following thyrotropin-releasing hormone injection into patients with anorexia nervosa. Acta Endocrinology, 81, 8.Google Scholar
Meikle, A. W. (1982) Dexamethasone suppression tests: usefulness of simultaneous measurement of plasma cortisol and dexamethasone. Clinical Endocrinology, 16, 401.Google Scholar
Mendlewicz, J., Van Cauter, E., Liukowski, P., L'Hermite, M. & Robyn, C. (1980) Current concepts: the 24-hour profile of prolactin in depression. Life Sciences, 27, 20152024.Google Scholar
Mitchell, J. E. & Bantle, J. P. (1983) Metabolic and endocrine investigations in women of normal weight with the bulimia syndrome. Biological Psychiatry, 18, 355365.Google ScholarPubMed
Mitchell, J. E., Pyle, R. L., Hatsukami, D. & Boutacoff, L. I. (1984) The dexamethasone suppression test in patients with bulimia. Journal of Clinical Psychiatry, 45, 508511.Google ScholarPubMed
Mussisi, S. M. & Garfinkel, P. E. (1985) Comparative dexamethasone suppression test measurements in bulimia, depression and normal controls. Canadian Journal of Psychiatry, 30, 190194.Google Scholar
Norris, P. D., O'Malley, B. P. & Palmer, R. L. (1985) The TRH test in bulimia and anorexia nervosa: a controlled study. Journal of Psychiatric Research, 19, 215219.Google Scholar
Piran, N., Kennedy, S., Garfinkel, P. E. & Owens, M. (1985) Affective disturbance in eating disorders. Journal of Nervous and Mental Disease, 173, 395400.Google Scholar
Pope, H. G., Hudson, J. I. & Jonas, J. M. (1983) Bulimia treated with imipramine: a placebo controlled double blind study. American Journal of Psychiatry, 140, 554558.Google Scholar
Pyle, R. L., Mitchell, J. E. & Eckert, E. D. (1981) Bulimia: a report of 34 cases. Journal of Clinical Psychiatry, 42, 6064.Google Scholar
Pyle, R. L., Halvorson, P. A., Newman, P. A. & Mitchell, J. E. (1986) The increasing prevalence of bulimia in freshman college students. International Journal of Eating Disorders, 5, 631647.Google Scholar
Raskind, M., Perskind, E., Rivard, M. F., Veith, R. & Barnes, R. (1982) Dexamethasone suppression test and cortisol circadian rhythm in primary degenerative dementia. American Journal of Psychiatry, 139, 14681471.Google Scholar
Robins, L. N., Helzer, J. E., Croughan, J. & Ratcliff, K. S. (1981) National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry, 38, 381389.Google Scholar
Russell, G. F. M. (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429448.Google Scholar
Siever, L. J. & Uhde, T. W. (1984) New studies and perspectives on the noradrenergic receptor system in depression: effects of adrenergic agonist clonidine. Biological Psychiatry, 19, 131156.Google ScholarPubMed
Swartz, C. & Dunner, F. D. (1982) Dexamethasone suppression testing of alcoholics. Archives of General Psychiatry, 39, 13091312.CrossRefGoogle ScholarPubMed
Swift, W. J., Andrews, D. & Barklage, N. E. (1986) The relationship between affective disorder and eating disorders. American Journal of Psychiatry, 143, 290299.Google Scholar
Vinik, A. F., Kalk, W. J., McLaren, H., Hendricks, S. & Pimstone, B. L. (1975) Fasting blunts the TSH response to synthetic TRH. Journal of Clinical Endocrinology and Metabolism, 40, 509511.Google Scholar
Walsh, B. T., Stewart, J. W., Roose, S. P., Glacks, M. & Glassman, A. H. (1984) Treatment of bulimia with phenelzine. Archives of General Psychiatry, 41, 11051109.Google Scholar
Walsh, B. T., Lo, E. S., Cooper, T., Lindy, D. C., Roose, S. P., Gladis, M. & Glassman, A. H. (1987) Dexamethasone suppression test and plasma dexamethasone levels in bulimia. Archives of General Psychiatry, 44, 797800.Google Scholar
Wong, P. Y., Mee, A. V. & Ho, F. F. K. (1979) A direct radioimmunoassay of serum Cortisol with in house I-tracer and preconjugated double antibody. Clinical Chemistry, 25, 914917.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.