The Evening Urine Cortisol Excretion Test in Depression

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Abstract
To the Editor.— The 1-mg dexamethasone suppression test (DST) has been used widely to investigate the pituitary-adrenal axis activity of psychiatric patients.1,2Among the various factors that limit the usefulness of the DST are compliance with the oral dose of dexamethasone, differences among subjects in dexamethasone pharmacokinetics, and concurrent intake of drugs that induce the metabolism of dexamethasone.3It was reported recently that cortisol determination in a single one-hour urine sample collected between 10 and 11 PM accurately identifies patients with Cushing's disease.4We would like to report our preliminary results on the usefulness of this procedure as a test for screening depressed patients with a pituitary-adrenal disturbance. We studied 15 depressed patients (12 inpatients and three outpatients) (age range, 24 to 71 years) and four healthy volunteers (age range, 36 to 62 years). Four patients had not taken drugs for at least one week prior to