Abnormal Results of Dexamethasone Suppression Tests in Nondepressed Patients With Diabetes Mellitus
Abstract
To investigate the specificity of the dexamethasone suppression test (DST) for the diagnosis of major depression in patients with diabetes mellitus, we administered 1 mg of dexamethasone to 30 nondepressed diabetics and to 58 normal controls at 11 PM. Diabetic subjects received hemoglobin A1 (Hb A1) determinations, the Hamilton Rating Scale for Depression (HRSD), and five to eight blood glucose determinations during the 48 hours surrounding the DST. Results demonstrated a significantly higher rate of nonsuppression (plasma cortisol level, greater than or equal to 5 micrograms/dL) at 4 PM the following day among diabetics (43%) than among controls (7%) but no difference between these groups in the rate of nonsuppression at 8 AM. Plasma cortisol level at 4 PM correlated with Hb A1 level but not with duration of illness, HRSD score, mean blood glucose level, or maximum blood glucose excursion. These results suggest that the results of the DST used as a diagnostic test for major depression must be interpreted with caution in patients with diabetes.
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Hyperactivity of the HPA axis and hyperinsulinemia are frequently observed in patients with type 1 and type 2 diabetes and in patients with abdominal adiposity.
“Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in association with hyperinsulinemia is frequently found in patients with type 1 and type 2 diabetes mellitus and in subjects with abdominal adiposity.”
From Supraphysiological Hyperinsulinemia Acutely Increases Hypothalamic-Pituitary-Adrenal Secretory Activity in Humans (1999) · cites this paper as [7]
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References 21 · Cited by 91
- Authors
- Hudson, J. I.
- Corresponding author
- Hudson, James I.
- ORCID
- Hudson, James I.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 1984-11-01
- Volume
- 41
- Issue
- 11
- Pages
- 1086
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2026167623
- Cited by
- 91
- References
- 21
- Citations by year
- 2026: 2 · 2024: 1 · 2021: 1 · 2020: 2 · 2018: 3 · 2016: 3 · 2015: 5 · 2014: 1 · 2013: 6 · 2012: 1
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- eScholarship@UMassChan (submittedVersion)
- Funders
- National Institutes of Health (T32AM007201)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- dexamethasone suppression test, diabetes mellitus, major depressive disorder, diagnostic specificity, plasma cortisol, HbA1, blood glucose
- MeSH terms
- Adult, Aged, Blood Glucose, Depressive Disorder, Dexamethasone, Diabetes Mellitus, Evaluation Studies as Topic, Female, Glycated Hemoglobin, Hospitalization, Humans, Hydrocortisone, Hypoglycemia, Male, Middle Aged, Psychiatric Status Rating Scales, Research Design, Diabetes Complications
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