AN ASSESSMENT OF HYPOTHALAMO-PITUITARY-ADRENAL AXIS FUNCTIONING IN NONDEPRESSED, EARLY ABSTINENT ALCOHOLICS

Chronic alcohol consumption has been shown to be associated with abnor malities in the regulation of the hypothalamo-pituitary-adrenal (HPA) axis in humans. However, conflicting data exist in the literature, wit h particular regard to studies performed in actively drinking or withd rawn alcoholics; in addition, the frequent presence of depressive dist urbances in such patients may importantly affect the neuroendocrine fi ndings. In this study, we investigated HPA function in 12 male alcohol ics, in whom the presence of depression and other possible confounding factors was excluded, during the first and second weeks after cessati on of ethanol intake. The plasma corticotropin (adrenocorticotropic ho rmone, (ACTH) and cortisol levels in response to both a stimulation te st with human corticotrophin-releasing hormone (CRH; 100 mu g IV) and an insulin (0.15 UI/kg IV)-induced hypoglycaemia (ITT) were measured; the cortisol response to a standard overnight dexamethasone (1 mg) sup pression test (DST) was also tested. While the mean baseline ACTH and cortisol levels, measured in the morning (0800-0830h), were not differ ent from those of controls, ACTH and cortisol responses to the CRH tes t were markedly reduced (area of secretion p <.01 and p <.05, compared to controls). Similarly, the patient group showed an almost absent AC TH and cortisol release following insulin infusion (area of secretion p <.01 compared to controls, in either case). In four patients, non-su ppression of plasma cortisol levels was seen on the DST, but no signif icant difference from normal suppressors was noted as far as the clini cal features were concerned. These findings suggest that impaired hypo thalamic and pituitary responsiveness, unrelated to depressive disturb ances, occurs in recently withdrawn chronic alcoholics. While the poss ible influence of the alcohol withdrawal syndrome shoud be taken into account, such a pattern may be due to increased activity of the HPA ax is, even in the face of preserved basal adrenal secretion. Whether the se findings reflect a direct effect of sustained ethanol exposure on t he components of the HPA axis, or a non-specific marker of impaired ad aptation in chronic alcoholics, deserves further investigation. Copyri ght (C) 1996 Elsevier Science Ltd.