Cortisol Dynamics and Test Performance of the Dexamethasone Suppression Test in 97 Psychiatrically Hospitalized Children Aged 3–16 Years

This report reviews baseline cortisol dynamics and the test performance of the dexamethasone suppression test (DST) in a study population of 97 psychiatrically hospitalized children aged 3–16 years. Only 5% of depressed patients failed to maintain a diurnal variation in cortisol secretion and elevated basal cortisols were a nonspecific finding in some depressed children and nondepressed controls. Fifteen of 34 children who met DSM-III criteria for Major Affective Disorder failed to suppress their serum cortisol below 5μg/dl following 1 mg of dexamethasone giving test sensitivity of 44%, specificity of 88% and diagnostic confidence of 68%. Nonsuppression was negligible (3% (1/34) in a wide range of nondepressed diagnostic categories), but 21% (4/19) children with Depressive Neurosis and 33% (2/6) with Adjustment Disorder with depressed mood also failed to suppress. Only 1/22 or 4.5% of the positive DST results would have been missed by drawing a single cortisol sample at 4:00 P.M. In spite of a weight range of 15–83 kg in the children, there was no significant difference in the percentage of depressed children who failed to suppress at high, medium or low dose of dexamethasone per kg body weight when a 1 mg standard dose was used in all children. However, when the high dose children were grouped by age, 9 young children in the 0–6-year age range showed poor sensitivity and specificity, indicating a need for further study of the effects of dose, age, weight and diagnostic variables in this population.