우울증 환자에서 Cortisol 일일변화 검사의 의의

The Diagnostic Significance of Diurnal Cortisol Test

This study was designed to investigate whether depressed patient showed increased plasma cortisol level compared with nondepressed patients and to examine whether diurnal variation is preserved or flattened in depressed patients and whether diurnal variation itself could be a useful diagnostic procedure in depression. We studied also the possible relationship between the diurnal variation of cortisol secretion and the degree of symptomatic improvement with antidepressant administration in major depression patients. The results were as follows * 1) The values of serum cortisol levels checked before antidepressant administration were 8.44士 4.89|jgAil, 5.74士 3.19나g/dl, 3.18土 3.5知g/dl，10.75士 5.23|jg/dl at 12AM, 4PM, 11PM and 8AM respectively in endogenous depression group, and 6.39 土 3.29[ig/dl, 6.25 ± 3.75(ig/dl, 2.74 士 1.85(ig/dl, 10.79± 4.77|ig/dl respectively in control group. There were no significant differences in serum cortisol levels between both groups (Table 2). 2) In 31 endogenous depressives, 18(58.1%) maintained diurnal variation of cortisol level and 13(41.9%) showed flattened variation. However, of 16 control group (schizophrenics and dysthymic disorder patients), 11(68.8%) maintained diurnal variation of cortisol secretion and 5(31.2%) showed flattened variation. As a result, the sensitivity, specificity and predictive value of diurnal cortisol test for endogenous depression were 42*%，67%, and 72% respectively 3) In 26 major depression patients, 11 patients who showed flattened diurnal variation of cortisol secretion had significantly high “agitative depression” factors of Hamiltion Rating Scale for Depression compared with 15 patients who maintained diurnal variation. 4) Among 15 major depression patients whose diurnal variation was preserved, 12(80.0%) showed marked improvement of depressive symptoms with antidepressant administration and 3(20.0%) did not. Among 11 major depression patients whose diurnal variation was disturbed, 6(54.5% ) improved and 5(45.5% ) did not. There were no significant differences in symptomatic improvement between two groups.