We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Difference Between Evening and Morning Thyrotropin Responses to Protirelin in Major Depressive Episode

Fabrice Duval, MD; Jean-Paul Macher, MD; Marie-Claude Mokrani, DSci
Arch Gen Psychiatry. 1990;47(5):443-448. doi:10.1001/archpsyc.1990.01810170043007.
Text Size: A A A
Published online


• We studied the thyrotropin response to protirelin challenge (200 μg intravenously) at 8 AM and at 11 PM after a minimum washout period of 10 days in 29 euthyroid inpatients who met DSM-III-R criteria for major depressive episode and 20 normal volunteer controls. The maximum increment in thyrotropin above baseline (△thyrotropin) was significantly greater at 11 PM than at 8 AM both in patients and in controls. However, the difference between 11 PM △thyrotropin and 8 AM △thyrotropin (△△thyrotropin) was significantly lower in patients than in controls. The lower △△thyrotropin found in patients could not be explained by differences in age, body weight, sex, or thyroid functioning. In the overall population, △△thyrotropin correlated with circadian variables (ie, mesor and amplitude). With the use of a criterion of less than 3 mU/L to define a blunted △△thyrotropin, the diagnostic sensitivity was 89% and the specificity was 95%. We suggest that △△thyrotropin has the advantage of taking into account chronobiologic influences in the interpretation of the protirelin/thyrotropin challenge, and this may explain the improved diagnostic value derived from this measure in the diagnosis of major depressive episode.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.