COMBINED DEXAMETHASONE CORTICOTROPIN-RELEASING HORMONE TEST IN ACUTE AND REMITTED MANIC PATIENTS, IN ACUTE DEPRESSION, AND IN NORMAL CONTROLS .1./

Hypothalamic-pituitary-adrenal system (HPA)-function in patients with mania (n = 11), depression (n = 11, unipolar) and in control subjects (n = 11) was studied; six of the acutely manic patients were reevaluat ed after a symptom-free interval of at least 6 months, The combined de xamethasone-suppression/human CRH-challenge test was used to probe HPA -system function. After CRH and dexamethasone pretreatment, ACTH and c ortisol release were significant ly increased in both manic and depres sed patients in comparison to the control group. In the remitted patie nts with mania, a significant decrease in hormonal release after DEX a nd CRH was evident when compared to the acute manic episode, but the d egree of CRH-stimulated hormone secretion in these remitted patients w as still significantly larger than in normal controls, This study demo nstrates that acute and remitted manic episodes are associated with a profoundly dysregulated HPA-system activity.