유동통 우울증군과 무동통 우울증군간의 부신 크기의 차이 : 전산화 단층 촬영상의 비교

Difference of Adrenal Gland Volume between Depression with Pain and Depression without Pain

This study was performed to find out if there is a volume difference o f adrenal gland between patients with depression with pain and those without pain. 18 patients with major depression, diagnosed by D SM - III-R criteria, were grouped into depression with pain(DW P ) and w ithout p ain(DW O P ) according to the presence or absence o f pain symptom measured by visual analogue scale(VAS). Patients who had physical illness were excluded and subjects were drug free at least for one week. Plain computed tomographic scan (CT) of abdomen, dexamethasone suppresion test(DST), Hamilton Rating Scale for Depression (HRSD ) and Beck Depression Inventory(BDI) were ckecked. Two radiologists estimated CT image of adrenal gland as ‘enlarged’ or ‘normal’ by its degree of thickening, surface irregularity and nodularity. Adrenal volume was measured by computer aided calculation after tracing the contour o f adrenal gland in each slices. The results were as follows : 1) Adrenal volume in DWP was larger than DWOP and the patients who had enlarged’ adrenal glands were more frequently found in DWP than DWOP . 2) Adrenal volume was positively correlated with severity of pain symptom. 3) DWP and D W O P did not differ in the incidence of DST non-suppressors, nor in the postdexamethasone serum cortisol level. Considering these results and previous findings suggesting serotonergic dysfunction in DWP together, supra-pituitary inhibitory feedback mechanism of cortisol regulation may be disturbed in D W P . But the possibility of compensatory hypertrophy due to unknown mechanism must be emphasized. Further studies are needed using ACTH stimulation test, cortisol suppression test and concom mitant measurement of serum ACTH and cortisol levels in resting state and under environmental stress.