CHANGES OF OPIOID MODULATION OF THE HYPOTHALAMO-PITUITARY-ADRENAL AXIS IN PATIENTS WITH SEVERE PREMENSTRUAL-SYNDROME

To assess the function of the hypothalamus-pituitary-adrenal axis in p atients with severe premenstrual syndrome (PMS) 28 patients and 14 asy mptomatic controls were studied during the mid- to late-luteal phase o f the menstrual cycle. The response of plasma cortisol to both high-do se naloxone and corticotropin-releasing hormone (CRH) was assessed. Na loxone stimulated a significant cortisol release in controls whereas i t was otherwise almost absent in patients. CRH stimulated a greater re lease of cortisol in patients than in controls. Fifteen patients met c riteria for either current anxiety and/or mood disorders. The cortisol secretion after both naloxone and CRH stimulations was similar for PM S patients with or without psychiatric disorders. These data indicate that endogenous opioids modulate the activity of the hypothalamus-pitu itary-adrenal axis, Irrespective of the concomitant presence of menstr ual migraine or psychiatric disorder, such control is altered in patie nts with severe PMS because of the possible hyposensitivity of opiate receptors. The hyperresponsiveness to CRH may be the consequence of th e reduced inhibition that endogenous opioids tonically exert on HPA ax is.