Title of article
Late-onset congenital adrenal hyperplasia: a treatable cause of anxiety
Author/Authors
Alan R. Jacobs، نويسنده , , Phyllis B. Edelheit، نويسنده , , Anton E. Coleman، نويسنده , , Andrew G. Herzog، نويسنده ,
Issue Information
روزنامه با شماره پیاپی سال 1999
Pages
4
From page
856
To page
859
Abstract
Background: Some intermediaries of cortisol synthesis, especially the sulfated ester of dehydroepiandrosterone (DHEAS), are picrotoxin-like antagonists of the γ-aminobutyric acid A (GABA-A) receptor and exert potent anxiogenic effects. We report 5 men and 7 women with refractory anxiety disorders, who had late-onset congenital adrenal hyperplasia (CAH), and in whom interactions between neuroactive steroids and anomalous brain substrates may have participated in the pathophysiology and treatment of anxiety.
Methods: Twelve patients with refractory anxiety disorders as defined by DSM-IV had elevated DHEAS and specific enzyme deficiencies diagnostic of CAH. All were treated with adrenal suppressive therapy using ketoconazole or low (physiologic) dose glucocorticoids. Anxiety was rated by the Tension Scale of the Profile of Mood States (POMS Tension) questionnaire before and during hormonal treatment.
Results: Reduction of DHEAS was associated with lower anxiety scores in all twelve cases. POMS Tension scores decreased by 55%. Hormonal treatment, which failed to lower DHEAS, was ineffective.
Conclusions: These findings suggest that late onset CAH can contribute to anxiety disorders and that adrenal suppressive therapy or inhibition of steroidogenesis with ketoconazole may be efficacious as adjuvant therapy.
Keywords
Anxiety , Dehydroepiandrosterone sulfate , Behavior , hormones , Adrenal
Journal title
Biological Psychiatry
Serial Year
1999
Journal title
Biological Psychiatry
Record number
501024
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