Impact of physical or sexual childhood abuse on plasma DHEA, DHEA-S and cortisol in a low-dose dexamethasone suppression test and on cardiovascular risk parameters in adult patients with major depression or anxiety disorders.

While the impact of childhood trauma on basal and dynamic cortisol regulation has widely been studied, the most abundant steroid hormones dehydroepiandrosterone (DHEA) and its sulphated derivative DHEA-S have received little attention in this context. One-hundred in-door patients suffering from major depression or an anxiety disorder filled in the Childhood Trauma Questionaire. A low dose dexamethasone suppression test (DST) measuring DHEA, DHEA-S and cortisol was performed. Furthermore, various cardiovascular risk parameters were measured. Forty-six percent of the patients reported a history of substantial physical or sexual childhood abuse. However, no significant differences in plasma DHEA or DHEA-S emerged in the DST between the traumatised group and the remaining patients. Basal plasma cortisol was significantly lower in the childhood trauma group. No impact of childhood trauma history on cardiovascular risk factor profile was detected. Current limited data about DHEA or DHEA-S in patients with childhood trauma are equivocal. Further study using more sophisticated assessment of trauma history and simultaneously measuring a multitude of putative biomarkers of traumatization are needed.

Psychosis-induced vitamin D deficiency with secondary hyperparathyroidism and osteoporotic fractures.

Vitamin D deficiency is common in patients with insufficient sunlight exposure and nutritional deficit in calcium and vitamin D. We present a patient with vitamin D deficiency, secondary hyperparathyroidism and resulting osteoporotic fractures caused or supported by psychosis-induced minimal sunlight exposure and nutritional deficits. To our knowledge, this is the first case where delusional ideas could have led to a vitamin D deficiency, secondary hyperparathyroidism and osteoporotic fractures. Similar clinical cases could be more often, but significantly underdiagnosed, among schizophrenia patients. An appropriate prevention by UV light exposure, food fortification and supplements is normally sufficient for patients at risk.