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The DST and TRH Test in Bulimia Nervosa

  • Allan S. Kaplan (a1), Paul E. Garfinkel (a2) and Gregory M. Brown (a3)

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.

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Corresponding author

CW 1-311, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada

References

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American, Psychiatric Association. (1987) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. Washington DC: American Psychiatric Association.
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.
Beck, A. T., Ward, C. H. & Mendelson, M. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.
Berger, M., Pirke, K. M. & Doerr, P. (1983) Influence of weight loss on the DST. Archives of General Psychiatry, 40, 585586.
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.
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.
Brown, G. M., Seggie, J. A., Chambers, J. W. & Ettigi, P. K. (1978) Psychoendocrinology and growth hormone: a review. Psychoneuroendocrinology, 3, 131153.
Caroll, B. S. (1982) The dexamethasone suppression test for melancholia. British Journal of Psychiatry, 140, 292304.
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.
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.
Castro, P., Lemaire, M., Toscano-Aguiler, M. & Herchuelz, P. (1983) Abnormal DST results in patients with chronic schizophrenia. American Journal of Psychiatry, 140, 1261.
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.
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.
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.
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.
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.
Dubois, A., Gross, H. A., Ebert, M. H. & Castell, D. O. (1979) Altered gastric emptying and secretion in primary anorexia nervosa. Gastroenterology, 77, 309323.
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.
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.
Fichter, M. M., Pirke, K. M. & Holsboor, E. (1986) Weight loss causes neuroendocrine disturbances: experimental study in healthy starving subjects. Psychiatry Research, 17, 6172.
Garbutt, J. L., Loosen, P. T., Tipermas, A. & Prange, A. J. (1983) The TRH test in patients with borderline personality. Psychiatry Research, 9, 107113.
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.
Garfinkel, P. E., & Moldofsky, H. (1982) Anorexia Nervosa: a Multidimensional Perspective. New York: Brunner Mazel.
Gerner, R. H. & Gwirtsman, H. E. (1981) Abnormalities of dexamethasone suppression test and urinary MHPG in anorexia nervosa. American Journal of Psychiatry, 138, 650653.
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.
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.
Gwirtsman, H. E., Roy-Byrne, P., Yager, J. & Gerner, R. G. (1983) Neuroendocrine abnormalities in bulimia. American Journal of Psychiatry, 140, 559563.
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.
Holt, S., Ford, M. J., Grant, S. & Heading, R. C. (1981) Abnormal gastric emptying in primary anorexia nervosa. British Journal of Psychiatry, 139, 550552.
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.
Hudson, J. I., Pope, H. G. & Jonas, J. M. (1983a) Phenomenologic relationship of eating disorders to major affective disorder. Psychiatry Research, 9, 345359.
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.
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.
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.
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.
Johnson, C. J., Lewis, C. & Hagman, J. (1984) The syndrome of bulimia. Psychiatric Clinics of North America, 7, 247273.
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.
Kiriike, N., Nishiwaki, S., Izumiya, Y. & Kawakita, Y. (1986) Dexamethasone suppression test in bulimia. Biological Psychiatry, 21, 328332.
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.
Kirschbaum, W. R. (1951) Excessive hunger as a symptom of cerebral origin. Journal of Nervous and Mental Disease, 113, 95114.
Levy, A., Dixon, K. N. & Malarkey, W. (1988) Pituitary response to TRH in bulimia. Biological Psychiatry, 23, 476484.
Loosen, P. T. & Prange, A. J. (1979) TRH in alcoholic men: endocrine responses. Psychosomatic Medicine, 41, 584585.
Loosen, P. T. & Prange, A. J. (1980) TRH: a useful tool for psychoneuroendocrine investigation. Psychoneuroendocrinology, 5, 6380.
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.
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.
Maeda, K., Kato, Y. & Yamaguchi, N. (1976) Growth hormone release following thyrotropin-releasing hormone injection into patients with anorexia nervosa. Acta Endocrinology, 81, 8.
Meikle, A. W. (1982) Dexamethasone suppression tests: usefulness of simultaneous measurement of plasma cortisol and dexamethasone. Clinical Endocrinology, 16, 401.
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.
Mitchell, J. E. & Bantle, J. P. (1983) Metabolic and endocrine investigations in women of normal weight with the bulimia syndrome. Biological Psychiatry, 18, 355365.
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.
Mussisi, S. M. & Garfinkel, P. E. (1985) Comparative dexamethasone suppression test measurements in bulimia, depression and normal controls. Canadian Journal of Psychiatry, 30, 190194.
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.
Piran, N., Kennedy, S., Garfinkel, P. E. & Owens, M. (1985) Affective disturbance in eating disorders. Journal of Nervous and Mental Disease, 173, 395400.
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.
Pyle, R. L., Mitchell, J. E. & Eckert, E. D. (1981) Bulimia: a report of 34 cases. Journal of Clinical Psychiatry, 42, 6064.
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.
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.
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.
Russell, G. F. M. (1979) Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429448.
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.
Swartz, C. & Dunner, F. D. (1982) Dexamethasone suppression testing of alcoholics. Archives of General Psychiatry, 39, 13091312.
Swift, W. J., Andrews, D. & Barklage, N. E. (1986) The relationship between affective disorder and eating disorders. American Journal of Psychiatry, 143, 290299.
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.
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.
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.
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.

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The DST and TRH Test in Bulimia Nervosa

  • Allan S. Kaplan (a1), Paul E. Garfinkel (a2) and Gregory M. Brown (a3)

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