Increased left ventricular mass in hypercortisolemic depressed patients: A hypothesis based on a case series Maria Gilles a,⇑ , Barbara Scharnholz a , Annika Marzina b , Marcel Kommer c , Stefan A. Wudy d , Michaela F. Hartmann d , Florian Lederbogen a , Andreas Meyer-Lindenberg a , Hendrik Michaely c , Michael Deuschle a a Dept. of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, 68159 Mannheim, Germany b Dept. of Neurology, University Medical Center Mannheim, 68167 Mannheim, Germany c Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany d Steroid Research and Mass Spectrometry Unit, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, 35390 Gießen, Germany article info Article history: Received 2 June 2014 Accepted 28 September 2014 Available online xxxx abstract Background: Hypercortisolemia in depressed patients is known to be related to changes in body compo- sition, especially increased ectopic fat and lowered bone mineral density. Both hypercortisolemia in patients with Cushing’s disease and depression in patients undergoing treatment with hemodialysis have been shown to be associated with increased left ventricular mass. Hypothesis: Increased activity of the hypothalamus–pituitary–adrenal (HPA) system in depressed patients is related to high left ventricular mass. Empirical data: To corroborate our hypothesis, we measured left ventricular mass in 5 depressed patients with clear evidence for HPA system activation (nonsuppression in dexamethasone suppression test [DST]; increased 24 h cortisol excretion) and 27 healthy controls. We found increased left ventricular mass in hypercortisolemic depressed patients compared to healthy controls (343 ± 97 vs. 176 ± 57 gr; p = 0.007). Conclusions: Depression is known to be related to an increased risk of cardial morbidity and mortality, although the risk architecture is not completely understood. We hypothesize that hypercortisolemic depression is associated with increased left ventricular mass, which is known to be a strong predictor for cardial mortality. Thus, a potential effect of activated stress-responsive systems on heart morphology may contribute to depressed patients’ increased cardiovascular risk. Ó 2014 Elsevier Ltd. All rights reserved. Introduction The comorbidity of major depressive disorder with ischemic heart disease is common and depression is known to be related to an increased risk for cardial morbidity and mortality. The patho- physiology of this bidirectional association is not fully understood. It is assumed that the activation of the hypothalamus–pituitary– adrenal (HPA) system, at least partially, explains insulin resistance and other cardiovascular risks of depressed patients [1]. Moreover, hypercortisolemic depression is related to changes in body compo- sition, especially increased visceral [2] and pericardial fat [3]. Both ectopic fat departments are considered independent predictors of the metabolic syndrome [4], which is also a major cardial risk factor. Hypothesis Due to its pleiotropic effects, cortisol may have even more effects on body composition than thus far assumed and could, potentially, affect left ventricular mass. Within this context, it has recently been reported that up to 70% of patients with active Cushing’s syndrome presented with abnormal left ventricular mass parameters. 42% of patients with Cushing’s disease presented con- centric hypertrophy and 23% concentric remodelling. Within that study major indices of systolic and diastolic functions, i.e. ejection fraction, were normal. Interestingly, upon remission of hypercorti- solism, left ventricular mass parameters ameliorated considerably, although abnormal values were still more frequent than in controls. Both cortisol excess and hypertension were considered to contribute to cardiac mass alterations [5]. Not only hypercorti- solemia, like in Cushing’s disease, but also depression per se may contribute to increased left ventricular mass, at least in depressed http://dx.doi.org/10.1016/j.mehy.2014.09.028 0306-9877/Ó 2014 Elsevier Ltd. All rights reserved. ⇑ Corresponding author at: Central Institute of Mental Health, J5, 68159 Mannheim, Germany. Tel.: +49 621 1703 2862; fax: +49 621 1703 3305. E-mail address: maria.gilles@zi-mannheim.de (M. Gilles). Medical Hypotheses xxx (2014) xxx–xxx Contents lists available at ScienceDirect Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy Please cite this article in press as: Gilles M et al. Increased left ventricular mass in hypercortisolemic depressed patients: A hypothesis based on a case series. Med Hypotheses (2014), http://dx.doi.org/10.1016/j.mehy.2014.09.028