A. Strohle et al., Increased ACTH concentrations associated with cholecystokinin tetrapeptide-induced panic attacks in patients with panic disorder, NEUROPSYCH, 22(3), 2000, pp. 251-256
Preclinical findings on the role of corticotropin releasing hormone (CRH) i
n stress and anxiety, on the interaction of CRH and cholecystokinin (CCK) i
n modulating anxiety, as well as the blunted corticotropin (ACTH) response
to CRH in panic disorder suggest that CRH may play a role in panic disorder
. To further characterize the role of the hypothalamic-pituitary-adrenocort
ical (HPA) system in panic disorder, we compared patients with and without
CCK tetrapeptide (CCK-4) induced panic attacks. Twenty-four patients with p
anic disorder were given injections of CCK-4 (25 mu g). Panic attacks, psyc
hopathological changes, as well as ACTH and cortisol secretion were recorde
d. Fifteen of the 24 patients experienced a panic attack after CCK-4. ACTH
secretion wa significantly higher in the patients with CCK-4-induced panic
attacks than in those without such attacks. The patients without CCK-4-indu
ced attacks had a brief but less pronounced increase in ACTH concentrations
. Cortisol concentrations were not significantly increased after CCK-4 admi
nistration. The increased ACTH concentrations suggest that the activation o
f the HPA system in CCK-4-inducd panic attacks plays a physiological role.
CRH may be involved in experimentally-occurring and perhaps in naturally-oc
curring panic attacks as well. [Neuropsychopharmacology 22:251-256, 2000] (
C) 2000 American College of Neuropsychopharmacology. Published by Elsevier
Science Inc.