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Increased 24-hour urinary cortisol excretion in patients with post-traumatic stress disorder & patients with major depression, but not in patients with fibromyalgia (FM)

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By Maes M, Lin A, Bonaccorso S, van Hunsel F, Van Gastel A, Delmeire L, Biondi M, Bosmans E, Kenis G, Scharpe S • • October 6, 1998

There is now firm evidence that major depression is
accompanied by increased baseline activity of the
hypothalamic-pituitary-adrenal (HPA) axis, as assessed by
means of 24-h urinary cortisol (UC) excretion. Recently, there
were some reports that fibromyalgia and post-traumatic stress
disorder (PTSD), two disorders which show a significant
amplitude of depressive symptoms, are associated with changes
in the baseline activity of the HPA axis, such as low 24-h UC
excretion . The aim of the present study was to examine 24-h UC
excretion in fibromyalgia and PTSD patients compared to normal
controls and patients with major depression. In the three
patient groups, severity of depressive symptoms was measured
by means of the Hamilton Depression Rating Scale (HDRS) score.
Severity of fibromyalgia was measured using a dolorimetrically
obtained myalgic score, and severity of PTSD was assessed by
means of factor analytical scores computed on the items of the
Composite International Diagnostic Interview (CIDI), PTSD
Module. Patients with PTSD and major depression had
significantly higher 24-h UC excretion than normal controls
and fibromyalgia patients. At a threshold value of > or = 240
micrograms/24 h, 80% of PTSD patients and 80% of depressed
patients had increased 24 h UC excretion with a specificity of
100%. There were no significant differences in 24-h UC
excretion either between fibromyalgia patients and normal
controls, or between patients with major depression and PTSD
patients. In the three patient groups, no significant
correlations were found between 24-h UC excretion and the HDRS
score. In fibromyalgia, no significant correlations were found
between 24-h UC excretion and the myalgic score. In PTSD, no
significant correlations were found between 24-h UC excretion
and severity of either depression-avoidance or anxiety-
arousal symptoms. In conclusion, this study found increased
24-h UC excretion in patients with PTSD comparable to that in
patients with major depression, whereas in fibromyalgia no
significant changes in 24- h UC were found.

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