Fourteen (33%) of 43 men hospitalized for alcohol abuse showed abnormal cortisol levels at 4 pm, 17 hours after administration of 1 mg of dexamethasone (median, five days after admission). Most (but not all) of these nonsuppressors showed multiple signs of alcoholic physical deterioration; there may be more than one mechanism by which alcohol abuse can lead to an abnormal result of this test. Suppressors and nonsuppressors reported similar alcohol consumption, symptoms of depression, and occurrence of depression among close relatives. Only two patients (5%) showed abnormal cortisol levels at 8 am, nine hours after administration of dexamethasone. These results suggest that, as a screen for primary depressive illness among recently abstinent alcohol abusers, the 4 pm cortisol level is not specific enough, but the 8 am level might be useful in patients who have no alcoholic relatives.
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