Background     Diagnosis/Treatment     Results    

Christine, 25, had experienced obsessive-compulsive tendencies as a child, with minor effects on her school performance due to low-level anxiety and depression. With puberty, her anxiety and depression increased as did obsessive fears of weight gain. This evolved into paranoid tendencies and racing thoughts concerning her body. She attempted suicide three times throughout high school and college.

Christine had always had irregular menstrual cycles. In recent years, she had experienced the loss of her period and weight gain. She was now on a mood stabilizer, antidepressant and low-dose major tranquilizer, but without much relief.

A reproductive endocrinologist found Christine had an elevated level of DHEAS, a hormone secreted by the adrenal gland above the kidneys. He diagnosed her with polycystic ovarian syndrome, which can affect a woman's menstrual cycle and appearance, among other things. Due to her psychiatric history, he referred her for a neuroendocrine evaluation to investigate a link.

Upon hearing Christine's history – treatment-resistant anxiety, elevated DHEAS, polycystic ovaries – I suspected late onset congenital adrenal hyperplasia, a condition where the adrenal glands have trouble making enough of the hormone cortisol. Cortisol is known as "the stress hormone" for its role in the body's longer-term response to stress. (Not to be confused with adrenalin, which also comes from the adrenal gland and is the "fight or flight" hormone.)

Tests confirmed a partial blockage in the adrenal pathway that makes cortisol. This explained the build-up of the DHEAS hormone, which is upstream to the blockage. Christine was treated with dexamethasone in a dose just high enough to replace her daily needs of cortisol. This had the effect of turning off her own cortisol pathway and thus lowering her DHEAS levels.

When she returned two months later, Christine's DHEAS was normal and her anxieties and obsessive thoughts were well-controlled, without any other changes in her psychiatric medications.

So what was the problem with her elevated DHEAS anyway? Due to the partial blockage in the pathway producing cortisol, Christine's adrenal system had ramped up its activity in order to maintain an adequate supply of cortisol. As a result, certain hormones upstream from the block, including DHEAS, were accumulating in her bloodstream. These hormones have been referred to as "neuro-active" because they stimulate the brain and exert anxiety-provoking effects. In effect, they were fanning the flames of Christine's anxiety disorder at these high levels. When they decreased to normal levels, her other medications worked well. We were even able to reduce the number and dose of those she was taking.

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