Metyrapone tests in patients with panic disorder

Background Studies of hypothalamic secretion of corticotropin-releasing hormone (CRH) in patients with panic disorder in the nonpanic state (using CRH tests) are contradictory. No data about the hypothalamic-pituitary response to metyrapone are available. Methods Study participants included 14 patients with panic disorder (DSM-IV criteria) and 14 healthy control subjects who underwent a standard overnight metyrapone test and a combined metyrapone/low-dose dexamethasone test. Results Significant treatment effects of metyrapone and combined metyrapone/dexamethasone were found on plasma corticotropin, cortisol, and 11-deoxycortisol, but no differences between patients and control subjects emerged. Considering visual analogue scale ratings of anxiety, tension, restlessness, and Beck Depression Inventory scores as covariates, no group effects were detected. Conclusions Standard overnight metyrapone tests do not support a hypersecretion of hypothalamic CRH in panic disorder. Furthermore, no evidence for increased glucocorticoid negative feedback in panic was found. Hypothalamic CRH secretion in the nonpanic state needs further research.