Table 2.

Hypothalamic pituitary adrenal axis functioning in panic disordered patients

Author	Control group	Sample	Cortisol levels	ACTH levels	DST	Stress test
Woods et al[71], 1987	13 HC	18 drug-free agoraphobic patients	Plasma cortisol not increased during PA	-	-	Exposure to phobic situations
Goldstein et al[76], 1987	61 HC; 38 outpatients with MDE	24 outpatients PD	↑ Basal plasma cortisol vs HC; = plasma cortisol vs MDE	-	=	Dex 1 mg
Cameron et al[74],1987	4 HC	8 PD patients	= In basal conditions; ↑ during spontaneous PA	-	-	-
Kathol et al[77], 1988	37 HC	65 PD subjects	↑ Urinary cortisol	-	-	-
Uhde et al[75], 1988	12 HC	12 drug-free PD patients	= Basal cortisol	-	-	-
Abelson et al[78], 1996	12 HC	20 PD subjects	↑ Overnight plasma cortisol; ↑ amplitude of ultradian secretory episodes	If low frequency of PA→ ↑ daytime ACTH levels and ↑ ACTH ultradian amplitude. If high frequency of PA→ shifted ACTH circadian cycles	-	-
Schreiber et al[30], 1996	10 MDE subjects, 10 HC	13 PD subjects wth agoraphobia	↑ Plasma cortisol versus controls	= Levels in PD vs controls and MDE subjects	92% non suppressors (higher than MDE subjects and controls)	69% abnormal Dex-CRH test (more than controls, but lesser than MDE subjects)
Bandelow et al[73], 2000	23 HC	23 PD patients	↑ Urinary and salivary cortisol	-	-	-
Coryell et al[81], 1989	38 HC	82 PD patients	-	-	25.6% non suppressors	Dex 1 mg
Coryell et al[80], 1991	-	72 PD patients	-	-	36% non suppressors
Erhardt et al[33], 2006	30 HC	30 PD subjects	↑ Basal plasma levels	↑ Basal	-	17% hyperresponder to Dex-CRH
Petrowski et al[82], 2010	34 HC	34 PD subjects	= Basal salivary levels; abnormally absent cortisol awakening response	-	-	Absent cortisol response to Trier Social Stress Test
Lieberman et al[79], 1983	22 MDE	10 PD	↑ Plasma cortisol	-	=	DST

HC: Healthy controls; DST: Dexamethasone suppression test; PA: Panic attack; MDE: major depressive episode; ACTH: Adrenocorticotropin hormone; PD: Panic disorder; Dex: Dexamethasone; CRH: Corticotropin releasing hormone.