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Dexamethasone suppression test abnormalities in multiple sclerosis

Relation to ACTH therapy

University of Chicago, Department of Neurology and the Brain Research Institute (Drs. Reder and Antel), and the Department of Psychiatry (Drs. hwy and Meltzer), Chicago, IL.

We studied the 1-mg overnight dexamethasone suppression test (DST) in patients with MS. In about 50% of patients, serum cortisol did not fall below 5.0 ug/dl. This percentage was similar in patients with major depression, but contrasted to 11% in normal controls. MS nonsuppressors were not more depressed than suppressors; dexamethasone bioavailability may have contributed because nonsuppressors had lower serum dexamethasone levels than suppressors. Suppressors improved in the week following ACTH therapy; nonsuppressors did not. Furthermore, serum dexamethasone values correlated positively with clinical response to ACTH treatment. The DST may be a useful neuroendocrine test of glucocorticoid sensitivity in MS patients.

Address correspondence and reprint requests to Dr. Reder, Department of Neurology, Box 425, University of Chicago, 5841 Maryland Avenue, Chicago, IL 60637.

Presented in part at the thirty-seventh annual meeting of the American Academy of Neurology, Dallas, TX, April 1985.

Supported in part by NIMH grant MH-30938 and MH-41683–01, National Institute on Aging grant AG-01798, and the Kroc Foundation. Dr. Rader is a Harry Weaver Neuroscience Scholar (JF 2027-A-1) and is supported by NIHCIDA 1 KO8 NS 01068–01. Dr. Lowy is supported by training grant T32-MH-14651 and grant MH 41683–01 from NIMH. Dr. Meltzer is a recipient of Research Career Scientist Award MH-47808 and grants MH-41683 and MH-41684 from NIMH.

Received May 13, 1986. Accepted for publication in final form August 12, 1986.

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