The Role of Hypothalamic-Pituitary-Adrenal Axis Dysfunction in the Attenuated Growth Hormone Response in Adolescents With Familial Loading for Affective Disorder

Birmaher et al¹ separated adolescents into those at high and low risk for affective disorders on the basis of family history and have demonstrated that those at high risk have a relatively attenuated growth hormone (GH) response to GH–releasing hormone (GHRH). We propose that rather than being a "trait marker for depression," these data reflect hypothalamic-pituitary-adrenal axis dysfunction that has been demonstrated in patients with high familial loading for affective disorders.² This view is also supported by preliminary evidence that variations in steroid function, particularly dehydroepiandrosterone levels, predict subsequent depression in adolescents.³