Increased ACTH concentrations associated with cholecystokinin tetrapeptide-induced panic attacks in patients with panic disorder

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.