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Depression and Abnormal Endocrinologic Tests-Reply

Mark S. Gold, MD; A. Carter Pottash, MD; Irl Extein, MD
JAMA. 1981;246(18):2032-2033. doi:10.1001/jama.1981.03320180024019.
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In Reply.—  In the evaluation of patients with presumed endocrine disorders, the presence of active major depression may, by producing falsepositive results, make the standard neuroendocrine testing protocols less useful. What may be a false-positive result for endocrinologic purposes (once ruled out) provides a reliable true-positive result for the confirmation of a psychiatric diagnosis of major unipolar depression. Psychiatric patients with major depression must be carefully evaluated for Cushing's syndrome,1,2 thyroid axis dysfunction,3 as well as a long list of other endocrine, medical, and neurologic illnesses.Adrenal hyperfunction is common in patients with major depression. This hyperfunction is not due to emotional distress, hospitalization, or anxiety per se but appears to be a concomitant manifestation of major depression. These depressed patients do not demonstrate clinical evidence of Cushing's disease but have diurnal cortisol and adrenocorticotropic hormone secretory abnormalities, hypersecretion, and failure to demonstrate adequate suppression in response to


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