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To the Editor.—
In the article "Diagnosis of Depression in the 1980s" (1981;245:1562) by Mark S. Gold, MD, et al two laboratory observations are described as confirmatory for a diagnosis of primary unipolar depression. These are the failure of dexamethasone to suppress blood cortisol secretion and the inability of thyrotropinreleasing hormone (TRH) to cause a rise of thyroid-stimulating hormone (TSH). However, these laboratory abnormalities are supportive of diagnoses of Cushing's syndrome and dysfunction of the hypothalamic-pituitary-thyroid axis, eg, primary hyperthyroidism. Do the patients classified as having a laboratoryconfirmed primary depression actually have endocrine disorders that warrant, but are not receiving, treatment? Please resolve this apparent dilemma.
Steinberg JS. Depression and Abnormal Endocrinologic Tests. JAMA. 1981;246(18):2032. doi:10.1001/jama.1981.03320180024018