Am J Psychiatry 1991; 148:1023-1025
Copyright © 1991 by American Psychiatric Association
Disturbances of hypothalamic-pituitary-adrenal axis functioning during ethanol withdrawal in six men
B Adinoff, D Risher-Flowers, J De Jong, B Ravitz, GH Bone, DJ Nutt, L Roehrich, PR Martin and M Linnoila
Laboratory of Clinical Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.
OBJECTIVE: Excessive exposure to glucocorticoids can have neurotoxic
effects. The behavioral, cognitive, and neurochemical changes observed
following the cessation of heavy drinking, therefore, may be associated
with disturbances of the hypothalamic-pituitary-adrenal (HPA) axis. To
investigate HPA axis disturbances during the ethanol withdrawal syndrome,
the authors examined diurnal changes in plasma cortisol in six
alcohol-dependent men following the abrupt discontinuation of alcohol
intake. METHOD: Plasma cortisol concentrations were quantified every 30
minutes for 24 hours in the early stage (1 day after cessation) and the
middle to late stage (3 days after cessation) of the ethanol withdrawal
syndrome as well as after the resolution of acute symptoms (8 days or more
after cessation). RESULTS: Plasma cortisol concentrations were almost twice
as high during acute withdrawal as they were following recovery. The
duration of the cortisol diurnal cycle on the first day of withdrawal was
negatively correlated with the severity of withdrawal. CONCLUSIONS: There
is a marked activation of the HPA axis associated with the ethanol
withdrawal syndrome. The authors hypothesize that this activation may
account for some of the signs and symptoms of acute and subacute
withdrawal. They discuss the potential long-term physiological effects of
the episodic increases in cortisol associated with repeated episodes of
ethanol withdrawal. The alterations in cortisol rhythmicity during early
withdrawal may also have clinical implications.
