Adrenal Cortex

Serum cortisol levels are slightly raised, without diurnal variation, and may not suppress with dexa-methasone overnight. Urinary 17-hydroxy and 17-keto steroids are decreased by 30-50%, but urinary-free cortisol may be increased. Corticotrophin-releasing factor (CRF) stimulation causes a subnormal corticotrophin rise but a normal or supernormal serum cortisol response. Levels of CRF in the cere-brospinal fluid are elevated. These changes in the hypothalamic-pituitary-adrenal axis are very similar to those seen in untreated depression.

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