DIFFERENTIAL-EFFECTS OF HYDROCORTISONE AND DEXAMETHASONE ON CORTISOL SUPPRESSION IN A CHILD PSYCHIATRIC POPULATION

The suppressive effect of hydrocortisone and dexamethasone on salivary cortisol was investigated in a 2-year study of pituitary-adrenal func tion in a variety of child psychiatric patients and healthy controls. Symptomatology was assessed using the Child Behavioral Checklist (CBCL ). Cortisol day profiles were assessed at 2-h intervals from 0800 to 2 000h on three occasions. Dexamethasone acid hydrocortisone were admini stered orally twice at 2000h, the doses being adjusted for bodyweight according to the standard dexamethasone suppression test. Fifty-one pa tients, including patients with dysthymia, oppositional defiant disord er, pervasive developmental disorder, and attention deficit hyperactiv ity disorder, and ten age and sex matched controls participated. Basal cortisol levels In patients were generally lower than in controls. Bo th dexamethasone and hydrocortisone were effective in suppressing sali vary cortisol, although dexamethasone was somewhat more potent and its effect lasted longer. Hyporesponsiveness to hydrocortisone, but not t o dexamethasone, distinguished patients with dysthymia and oppositiona l defiant disorder From controls. Responsiveness to hydrocortisone was correlated with the symptom clusters social problems and anxious/depr essed. The data support the idea that there exist syndrome aspecific d isturbances in feedback activity beyond the level of the pituitary, i. e. at the hypothalamic level, at an early age. From this perspective, hydrocortisone suppression is a useful tool for studying pituitary-adr enal function in children. Behavioral correlates of these disturbances of pituitary-adrenal function should be determined. (C) 1998 Elsevier Science Ltd. All rights reserved.