Baseline Cortisol Levels Research Articles

Effects of capture on stress-axis measures in endangered little brown bats (Myotis lucifugus)

Abstract Little brown bats (Myotis lucifugus) are a widely distributed species in North America that have been decimated by the fungal disease white-nose syndrome. As such, little brown bats are the focus of monitoring and research initiatives that often include capturing and handling free-ranging individuals. We examined the stress response of 198 adult female little brown bats after being captured from three bat houses, during the summer. Our objective was to inform best practices to researchers capturing and handling bats in the wild. We compared the stress response among bats held for <3 min (baseline), 15–30 min, or >30 min, and then among bats held alone or in a group with conspecifics. We measured the levels of plasma total and free cortisol, maximum corticosteroid binding capacity (MCBC), and blood glucose. Relative to baseline, total and free cortisol levels were significantly higher in bats held for 15–30 min and higher still in those held for > 30 min. Blood glucose levels were elevated after >30 min of holding. MCBC levels showed no differences among holding times. We detected a weak effect of social holding condition, with solitary-held bats having lower total cortisol levels than group-held bats, but MCBC, free cortisol, and blood glucose levels showed no effect of social holding condition. Our findings demonstrate that capture time should be minimized and suggest that little brown bats should be handled and released within 30 min of capture as means of reducing stress. Further, solitary holding did not appear to increase stress measures, which supports holding bats individually after capture, instead of in groups, to reduce risk of pathogen and parasite transmission.

Relationship Between Decreased Cortisol and Development of Chronic Pain in Traumatically Injured

The relationship between pain and stress is widely accepted, yet the underlying neuroendocrine mechanisms are poorly understood. Cortisol secretion during a stress response, may distract attention from a painful stimulus, inhibiting pain. However, when pain is the stressor, cortisol secretion may intensify the pain experience and condition a fear-based memory of pain. This study attempts to determine the relationship between acute pain, chronic pain, and cortisol in the traumatically injured population. Secondary analyses of a prospective observational study with participants from a Midwestern Adult Level I Trauma Center post traumatic injury, with interview and serum cortisol taken at hospitalization (baseline) and 6 mo after discharge, was completed using Ward's Method hierarchical cluster analysis, Pearson's correlations, and linear regressions. Two major clusters were identified. The Chronic Pain group were those who had severe pain at discharge and continued to have severe pain as defined by Numeric Pain Score. The Resolved Pain group were those who had moderate pain at discharge and their pain improved or resolved. Pain score at discharge significantly, negatively correlated with baseline cortisol levels (r=-0.142, P=0.02). Minority status, single individuals, low cortisol at baseline, and greater psychological distress at baseline significantly increased the likelihood of developing chronic pain. Low cortisol and greater psychological stress, which are also associated with minority status and single individuals, contribute to chronic pain in the traumatically injured population. Trauma victims without an adequate cortisol response to acute injury and pain are at risk for development of chronic pain after injury.

Impaired adrenal cortex reserve in patients with rheumatic and musculoskeletal diseases who relapse upon tapering of low glucocorticoid dose.

To examine adrenal cortex reserve in patients with rheumatic and musculoskeletal diseases (RMD) who relapse upon tapering of low glucocorticoid dose, despite concomitant treatment with disease-modifying anti-rheumatic drugs (DMARDs). A morning standard dose of 250 mcg tetracosactide (Synacthen test) was given in 25 consecutive patients (13 rheumatoid arthritis, 2 psoriatic arthritis, 5 systemic lupus erythematosus, 2 dermatomyositis, 1 systemic sclerosis, 2 temporal arteritis) at the time of relapse upon small reductions (1-2 mg daily) of low prednisolone dose (<7.5 mg daily), while being on stable concomitant treatment with methotrexate, leflunomide, hydroxychloroquine, azathioprine, mycophenolate, tofacitinib, belimumab, anti-TNF, anti-IL-6 or anti-IL-1 regimens (n=14; 3; 9; 1; 2; 1; 1; 5; 2; 1, respectively). Sex-matched apparently healthy individuals (n=45) served as controls. Baseline cortisol levels and time-integrated cortisol response to tetracosactide were lower in patients than controls (12.01±4.47 vs. 15.63±4.16 mcg/dl, p=0.001, and 1050±286 vs. 1284±182, p<0.001, respectively). No significant associations were observed between the cortisol response to tetracosactide and age, duration of disease or glucocorticoid treatment. An abnormal Synacthen test, indicative of adrenal insufficiency, presumably secondary to chronic glucocorticoid administration, was noted in 5/25 patients. The remaining 20 patients (80%) had normal Synacthen test demonstrating, however, lower cortisol response than controls, independently of age (β-coefficient=-0.373, p=0.033). Patients with RMD in remission under DMARDs who relapse upon concomitant low glucocorticoid dose tapering should be tested for iatrogenic adrenal insufficiency. Whether a marginally normal Synacthen test should discourage further attempts to withdraw glucocorticoid treatment in these patients warrants further investigation.

A characterization of cortisol level and adrenal reservation in human cardiopulmonary arrest: systematic review and meta-analysis

BackgroundCardiopulmonary arrest (CPA) is an urgency, which is associated with high mortality. This systematic review evaluated the relationship between baseline cortisol level and the outcome of resuscitated CPA patients.MethodsWe searched the following databases: PubMed, Scopus, ISI Web of Science, and Google Scholar. Relevant observational and controlled trials were explored from inception by April 2020. The quality of the articles was assessed using the Newcastle-Ottawa Scale (NOS).ResultsFinally, five cohort studies (n = 201 participants in total) were eligible for including in the meta-analysis. The results of this meta-analysis showed that although the baseline serum cortisol levels were higher in survivors of cardiac arrest compared with non-survivors, the differences between groups do not reach a significance level (Hedges’ g = 0.371, 95% CI, −0.727, 1.469, P value = 0.508). Between-study heterogeneity was statistically significant (Cochrane Q test: P value < 0.001, I2 = 89.323).ConclusionsThe result of the present meta-analysis was suggestive of a higher baseline serum cortisol levels in survivors of CPA. Future randomized controlled studies with a large sample size will determine the exact relationship between adrenal reservation and the eventual outcome of patients with CPA.Systematic review registrationPROSPERO CRD42018085468

The possibility of short-term hypothalamic-pituitary-adrenal axis suppression with high-volume, high-dose nasal mometasone irrigation in postsurgical patients with chronic rhinosinusitis.

Medically refractory chronic rhinosinusitis (CRS) is often treated with functional endoscopic sinus surgery (FESS) and high-volume steroid nasal irrigation. While budesonide is the most common steroid irrigation for this indication, mometasone has a superior pharmacokinetic profile, which may allow dose escalation. The safety and efficacy of mometasone at higher concentrations than previously used in treating CRS have not been explored. Patients were recruited from a tertiary level clinic between June 2018 and December 2019. Inclusion criteria included adults (>18 years); CRS diagnosis; previous FESS; pre-treatment morning cortisol within normal range; minimum of twice daily high-volume sinonasal mometasone irrigations (total dose of 4 mg) for 12 weeks; and post-treatment morning cortisol measured within 2 weeks following the study period. Patients with potential for endogenous or exogenous disruption of the HPA axis were excluded. 14 patients were enrolled in this prospective cohort study. In all but one patient, pre- and post-treatment morning cortisol levels were not significantly different and were within normal limits (6.7-25.4 μg/dL). Following an uninterrupted 12-week treatment course, no evidence of HPA axis suppression was found (P = 0.915). The single patient who was found to have a low (1.3 μg/dL) post-treatment morning serum cortisol level reportedly received an intraarticular steroid shot several days prior to the blood draw. She remained asymptomatic and her rechecked serum cortisol was within normal limits at 12.3 μg/dL. High-volume 2 mg twice daily sinonasal mometasone irrigations did not cause HPA axis suppression in a representative sample of patients with refractory CRS post-FESS with normal baseline cortisol levels.

Elevated cortisol lowers thermal tolerance but results in limited cardiac remodelling in rainbow trout (Oncorhynchus mykiss) experiencing chronic social stress.

Juvenile rainbow trout (Oncorhynchus mykiss) held in pairs form dominance hierarchies in which subordinate individuals experience chronic social stress accompanied by lowered thermal tolerance (assessed as the critical thermal maximum, CTmax). Here, we tested the hypothesis that chronic elevation of circulating cortisol levels reduces thermal tolerance in subordinate trout. In support of this hypothesis, subordinate trout that recovered from social stress for 48 h, a period sufficient to return cortisol to normal baseline levels, no longer showed reduced CTmax. Further, thermal tolerance was not restored in subordinates treated with cortisol during recovery from social stress. To explore possible mechanisms underlying the effect of chronic stress on CTmax, we also tested the hypothesis that chronic cortisol elevation induces cardiac remodelling in subordinate trout, as previously reported for cortisol-treated rainbow trout. Ventricle mass and cardiac hypertrophy markers were unaffected by social stress. Picrosirius Red staining revealed a trend for lower collagen levels in the ventricles of subordinate relative to dominant trout. However, collagen type I transcript and protein levels, and markers of collagen turnover were unaffected. Indicators of cardiac function, including ventricle passive stiffness and intrinsic heart rate (fH), similarly were unaffected. In vivo fH was also similar between subordinate and dominant fish. Nevertheless, in keeping with their lower CTmax, subordinate fish exhibited cardiac arrhythmia at significantly lower temperatures than dominant fish during CTmax trials. Thus, high baseline cortisol levels in subordinate trout result in lowered thermal tolerance, but 5 days of social stress did not greatly affect cardiac structure or function.

Cardiac Arrest in a Child with Non-classic Lipoid Congenital Adrenal Hyperplasia Associated with a New STAR Gene Mutation

Abstract Introduction: Steroidogenic acute regulatory (STAR) protein regulates steroid hormone synthesis by transporting cholesterol into mitochondria. STAR gene mutations lead to lipoid congenital adrenal hyperplasia (LCAH), the rare but most severe form of congenital adrenal hyperplasia in children. We present an unusual case with an episode of cardiac arrest in a young girl during an acute febrile illness and later she was diagnosed with adrenal insufficiency secondary to a non-classic LCAH. Case: 2-year 11-month-old previously healthy white female was brought to an urgent care clinic due to severe lethargy and a seizure-like activity during a fever illness. She was found to have an undetectable blood glucose level and went into cardiac arrest shortly after arrival. CPR was performed for approximately 11 minutes. She then developed sever respiratory distress and was intubated. She was transferred to the PICU with IV sodium bicarbonate given en route. On admission, her body weight was 13.26 kg (36.80th percentile), height 90 cm (17.56th percentile), and BMI 16.17 (62.88th percentile). Her physical exam revealed normal external female genitalia and normal skin pigmentation. Lab evaluation revealed normal sodium and potassium but elevated anion gap, hyperuricemia, elevated creatinine kinase, abnormal liver function tests and abnormal coagulation profile. Brain MRI revealed findings consistent with hypoxic-ischemic encephalopathy. Renal function improved within 24 hours and hepatic function returned to normal after 20 days. Due to her severe hypoglycemic event, a high-dose ACTH stimulation test was performed. The results were consistent with adrenal insufficiency: baseline cortisol level, 7.3 μg/dL; 30 minutes cortisol, 7.8 μg/dL; 60 minutes cortisol, 9 μg/dL (normal response, ≥18 mcg/mL at 30 or 60 minutes). The baseline ACTH level was significantly elevated, 1688 pg/mL (0–46) as well as the renin activity, 24.3 ng/hour (1.7–11.2). Genetic testing revealed a 46 XX karyotype. STAR gene analysis identified compound heterozygosity; a novel deletion (c.811delC, p.Leu271Cysfs*50) and a previously reported missense mutation (c.661G&amp;gt;A, p.Gly221Ser). The girl is now 11 years old and exhibits normal growth, normal cognitive development, and she has developed early signs of puberty (Tanner stage 2 for breast). She takes daily hydrocortisone, fludrocortisone and stress dose hydrocortisone as needed. Conclusion: In non-classic LACH, the onset is generally late or not acute. Initial clinical features are variable and nonspecific. For this reason, non-classic LCAH may be overlooked. Adrenal crisis is a life-threatening complication, and it is important that clinicians are aware of the clinical features of non-classic LCAH and consider it in the differential diagnoses. Genetic testing for STAR should be considered in individuals with non-autoimmune primary adrenocortical insufficiency.

Vasovagal reactions following venepuncture result in aberrant stress-induced cortisol levels

Venepuncture is recognized as a potent stressor and, by activating the hypothalamic-pituitary-adrenal (HPA) axis, can interfere with measuring subsequent HPA axis indices such as cortisol. A resting period of 110 min is recommended between venepuncture and the commencement of psychosocial stress induction or cortisol measurement to allow cortisol levels to return to baseline first. In experiment 1 (n = 65), in which stress induction occurred 120 min after venepuncture, we observed three cortisol stress response patterns: conventional response (“responders”, 77%), conventional non-response (“non-responders”, 6.15%), and aberrant non-response characterized by high baseline (pre-stress) cortisol levels (“high-baseliners”, 16.9%). Based on subjective clinical observation, the aberrant non-response was exclusively present in those who experienced vasovagal reactions during venepuncture, ranging from nervousness, lightheadedness, nausea, feeling of being extremely hot or cold, confusion, slight inability to speak, weakness and visual disturbances, to loss of consciousness (syncope). In experiment 2 (n = 79), we showed that allowing 210 min between venepuncture and stress induction permits the return of cortisol levels back to baseline even in participants who experience vasovagal reactions, thereby allowing for the exhibition of a conventional cortisol stress response. In sum, while 110 min may be sufficient to circumvent the usual effects of venepuncture on cortisol levels, 210 min are needed to effectively adjust for the effects of venepuncture-induced vasovagal reactions and the subsequent sustained rise in cortisol. Allowing sufficient time between venepuncture and stress induction or cortisol measurement should also prevent misclassification of participants who show aberrant responses as non-responders or anticipatory responders.

Vasopressin surrogate marker copeptin as a potential novel endocrine biomarker for antidepressant treatment response in major depression: A pilot study

IntroductionMajor depressive disorder (MDD) constitutes the leading cause of disability worldwide. Although efficacious antidepressant pharmacotherapies exist for MDD, only about 40-60% of the patients respond to initial treatment. However, there is still a lack of robustly established and applicable biomarkers for antidepressant response in everyday clinical practice.ObjectivesThis study targets the assessment of the vasopressin (AVP) surrogate marker Copeptin (CoP), as a potential peripheral hypothalamic-level biomarker of antidepressant treatment response in MDD.MethodsWe measured baseline and dynamic levels of plasma CoP along with plasma ACTH and cortisol (CORT) in drug-naive outpatients with MDD before and after overnight manipulation of the hypothalamic-pituitary-adrenal (HPA) axis [i.e., stimulation (metyrapone) and suppression (dexamethasone)] on three consecutive days and their association with treatment response to 4 weeks of escitalopram treatment.ResultsOur findings suggest significantly higher baseline and post-metyrapone plasma CoP levels in future non-responders, a statistically significant invert association between baseline CoP levels and probability of treatment response and a potential baseline plasma CoP cut-off level of above 2.9 pmol/L for future non-response screening. Baseline and dynamic plasma ACTH and CORT levels showed no association with treatment response.ConclusionsThis pilot study provide first evidence in humans that CoP may represent a novel, clinically easily applicable, endocrine biomarker of antidepressant response, based on a single-measurement, cut-off level. These findings, underline the role of the vasopressinergic system in the pathophysiology of MDD and may represent a significant new tool in the clinical and biological phenotyping of MDD enhancing individual-tailored therapies.

Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients.&#x0D; Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated.&#x0D; Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p&lt;0.001).&#x0D; In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery.&#x0D; According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p&lt;0.001), in group II - by 10.1% (p&lt;0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p&lt;0.001), in group II - by 6.3% (p&lt;0.001).&#x0D; On the fifth postoperative day, no significant differences in baseline values ​​between the Luria test and the MMSE scale were detected.&#x0D; Conclusions. The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient.&#x0D; According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period

Sex, Type of Surgery, and Surgical Site Infections Are Associated with Perioperative Cortisol in Colorectal Cancer Patients.

Excessive endocrine response to trauma negatively affects patients’ well-being. Cortisol dynamics following robot-assisted colorectal surgery are unknown. We aimed at determining the impact of cancer pathology and surgery-related factors on baseline cortisol levels and analyzed its time-profile in colorectal cancer patients undergoing open or robot-assisted surgery. Cortisol levels were measured using liquid chromatography quadrupole time-of-flight mass spectrometry. Baseline cortisol was not associated with any patient- or disease-related factors. Post-surgery cortisol increased by 36% at 8 h and returned to baseline on postoperative day three. The cortisol time profile was significantly affected by surgery type, estimated blood loss, and length of surgery. Baseline-adjusted cortisol increase was greater in females at hour 8 and in both females and patients from open surgery group at hour 24. Solely in the open surgery group, cortisol dynamics paralleled changes in interleukin (IL)-1β, IL-10, IL-1ra, IL-7, IL-8 and tumor necrosis factor (TNF)-α but did not correlate with changes in IL-6 or interferon (IFN)-γ at any time-point. Cortisol co-examined with C-reactive protein was predictive of surgical site infections (SSI) with high accuracy. In conclusion, patient’s sex and surgery invasiveness affect cortisol dynamics. Surgery-induced elevation can be reduced by minimally invasive robot-assisted procedures. Cortisol and C-reactive protein as SSI biomarkers might be of value in the evaluation of safety of early discharge of patients.

Early maternal and paternal caregiving moderates the links between preschoolers' reactivity and regulation and maturation of the HPA-immune axis.

While early caregiving and child's temperamental dispositions work in concert to shape social-emotional outcomes, their unique and joint contribution to the maturation of the child's stress and immune systems remain unclear. We followed children longitudinally from infancy to preschool to address the buffering effect of early parenting on the link between temperamental dysregulation and hypothalamic-pituitary-adrenal (HPA)-immune axis in preschool-aged children. Participants included 47 typically developing children and their 94 parents in both mother-father and two-father families followed across the first 4-years of family formation. In infancy, we observed parent-infant synchrony and measured parental oxytocin; in preschool, we observed temperamental reactivity and self-regulation and assessed children's cortisol and secretory Immunoglobulin A (s-IgA), biomarkers of the stress and immune systems. Greater self-regulation and lower negative emotionality were associated with lower baseline s-IgA and cortisol, respectively. However, these links were defined by interactive effects so that preschoolers with low self-regulation displayed higher s-IgA levels only in cases of low parent-infant synchrony and negative emotionality linked with greater baseline cortisol levels only when parental oxytocin levels were low. Results emphasize the long-term stress-buffering role of the neurobiology of parental care, demonstrate comparable developmental paths for mothers and fathers, and delineate the complex developmental cascades to the maturation of children's stress-management systems.

Occult Adrenal Insufficiency in Renal Amyloidosis Patients.

ObjectiveSystemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition.MethodsPatients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 μg, intravenously) were evaluated, and free cortisol index (FCI) was calculated.ResultsTwenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients’ stimulated cortisol levels at the 60th minute were lower [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. The 60th-minute total cortisol levels of 8 of the 20 (40%) amyloidosis patients were <500 nmol/L, but only three of these 8 patients had stimulated FCI <12 nmol/mg suggesting an adrenal insufficiency (15%).ConclusionACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.

Aseptic femur head necrosis revealing Cushing's disease: a rare presentation

Background: Cushing's disease is an endocrine disorder and may be associated with non-traumatic osteonecrosis of the hip. We report the case of avascular necrosis of the femoral heads (AVNFH) as the presenting manifestation of Cushing's disease. Case presentation: A 29-year-old male patient was referred to our department because of non-traumatic bilateral hip pain evolving for two years. The pain was associated with lameness when walking. He noticed a drop in libido since one year with erectile dysfunction. Physical examination revealed facio-truncal obesity, abdominal violaceous striae, dorsal hyper-kyphosis, a pain and limitation of internal rotation of the left hip with a Lequesne index of 16. The standard radiography showed a loss of sphericity of the left femoral head with an aspect of eggshell. The MRI confirmed the diagnosis of a bilateral AVNFH. The baseline cortisol level was 287 ng/ml. AVNFH as the presenting manifestation of Cushing's disease was suspected and confirmed by a pituitary MRI which revealed a pituitary adenoma. A discharge of the hips was indicated. The patient underwent surgical resection of the adenoma and was referred to the endocrinology department. The histopathological examination confirmed the diagnosis of pituitary adenoma (corticotrope adenoma). The patient has also received an intravenous perfusion of 5 mg of Zoledronic acid. The follow up was marked by the regression of the symptoms of Cushing's disease and the hip pain. Conclusion: AVNFH as the presenting manifestation of Cushing's disease is rarely described. Hence, it’s needed to exclude endogenous hypercorticism in any patient with idiopathic osteonecrosis.

Association between Baseline Cortisol Serum Concentrations and the Effect of Prophylactic Hydrocortisone in Extremely Preterm Infants

To define nomograms of serum cortisol values before 24hours of postnatal life for extremely preterm infants and determine whether baseline cortisol values affect the benefit/risk ratio of prophylactic hydrocortisone to improve survival without bronchopulmonary dysplasia (BPD). We performed a predefined secondary analysis of the multicenter randomized controlled PREMILOC trial that included inborn infants delivered before 28weeks of gestation. Nomograms of baseline serum cortisol values measured in 325 enrolled patients were determined for male and female neonates and correlated to perinatal events. BPD-free survival and severe adverse events were analyzed in placebo and hydrocortisone groups according to the cortisol z score in multivariate logistic regression models. Increased cortisol levels measured before 24hours following birth were associated with a significantly higher chance of BPD-free survival only in placebo-treated infants (aOR [95% CI] 1.57 [1.08-2.27], P=.02) based on sex-specific nomograms for baseline cortisol levels. The cortisol z score for infants treated with prophylactic hydrocortisonepredicted a risk of high-grade intraventricular hemorrhage (aOR [95% CI] 1.82 [1.06-3.15], P=.03) and spontaneous intestinal perforation (aOR [95% CI] 4.81 [1.34-17.22], P=.02). We found no predictive value of baseline cortisol levels for BPD-free survival in infants born extremely preterm treated with hydrocortisone. However, high cortisol levels early after birth were associated with a greater risk of severe intraventricular hemorrhage and spontaneous intestinal perforation in infants treated with hydrocortisone and, therefore, a lower benefit/risk ratio for the treatment. EudraCT 2007-002041-20, ClinicalTrial.gov: NCT00623740.

Early social experience has life-long effects on baseline but not stress-induced cortisol levels in a cooperatively breeding fish

In cooperatively breeding cichlid fish, the early social environment has lifelong effects on the offspring's behaviour, life-history trajectories and brain gene expression. Here, we asked whether the presence or absence of parents and subordinate helpers during early life also shapes fluctuating levels of cortisol, the major stress hormone in the cichlid Neolamprologus pulcher. To non-invasively characterize baseline and stress-induced cortisol levels, we adapted the ‘static’ holding-water method often used to collect waterborne steroid hormones in aquatic organisms by including a flow-through system allowing for repeated sampling without handling of the experimental subjects. We used 8-year-old N. pulcher either raised with (+F) or without (−F) parents and helpers in early life. We found that N. pulcher have a peak of their circadian cortisol cycle in the early morning, and that they habituated to the experimental procedure after four days. Therefore, we sampled the experimental fish in the afternoon after four days of habituation. −F fish had significantly lower baseline cortisol levels, whereas stress-induced cortisol levels did not differ between treatments. Thus, we show that the early social environment has life-long effects on aspects of the physiological stress system of the Hypothalamic-Pituitary-Interrenal (HPI) axis. We discuss how these differences in physiological state may have contributed to the specialization in different social and life-history trajectories of this species.

Serum cortisol, cerebral amyloidosis, and neurodegeneration: A longitudinal study

AbstractBackgroundAlthough elevated blood cortisol has been repeatedly associated with Alzheimer`s disease (AD) and related cognitive decline, the pathological links underlying the association remain poorly understood. In this context, we aimed to investigate the relationship between serum cortisol and AD neuroimaging markers including amyloid beta protein (Aβ) deposition, tau deposition, AD‐signature region cerebral glucose metabolism (AD‐CM), AD‐signature region cortical thickness (AD‐CT), and adjusted hippocampal volume (HVa).MethodThis study was part of the of the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer’s Disease (KBASE), an ongoing prospective cohort study. A total of 503 middle‐aged and elderly adults, including cognitively normal adults and individuals with mild cognitive impairment and AD dementia, underwent comprehensive clinical and neuropsychological assessments, 11C‐Pittsburgh compound B (PiB)‐PET, 18F‐deoxyglucose (FDG)‐PET, MRI, and serum cortisol level quantification at baseline and 2 years later. A subset of subjects also received 18F‐AV‐1451 PET during the follow‐up evaluation.ResultAt baseline, a significant positive association was found between serum cortisol level and global cerebral Aβ deposition after controlling for the effects of potential confounders (i.e., age, sex, APOE4 status, cognitive status, vascular risk, and depression). In addition, cortisol level showed significant inverse association with AD‐CM even after controlling for global Aβ retention as well as the confounders. There was no significant relationship between cortisol and cerebral tau deposition. In regard of longitudinal changes of AD markers, baseline cortisol level also had significant positive association with increase of cerebral Aβ deposition over 2 years, but not with changes of any neurodegeneration markers.ConclusionThe findings indicate that high serum cortisol contribute to AD processes through pathological cerebral Aβ deposition. Additionally, cortisol appears to directly affect neurodegeneration in AD‐signature brain regions via Aβ‐independent mechanisms.

Linking human male vocal parameters to perceptions, body morphology, strength and hormonal profiles in contexts of sexual selection

Sexual selection appears to have shaped the acoustic signals of diverse species, including humans. Deep, resonant vocalizations in particular may function in attracting mates and/or intimidating same-sex competitors. Evidence for these adaptive functions in human males derives predominantly from perception studies in which vocal acoustic parameters were manipulated using specialist software. This approach affords tight experimental control but provides little ecological validity, especially when the target acoustic parameters vary naturally with other parameters. Furthermore, such experimental studies provide no information about what acoustic variables indicate about the speaker—that is, why attention to vocal cues may be favored in intrasexual and intersexual contexts. Using voice recordings with high ecological validity from 160 male speakers and biomarkers of condition, including baseline cortisol and testosterone levels, body morphology and strength, we tested a series of pre-registered hypotheses relating to both perceptions and underlying condition of the speaker. We found negative curvilinear and negative linear relationships between male fundamental frequency (fo) and female perceptions of attractiveness and male perceptions of dominance. In addition, cortisol and testosterone negatively interacted in predicting fo, and strength and measures of body size negatively predicted formant frequencies (Pf). Meta-analyses of the present results and those from two previous samples confirmed that fonegatively predicted testosterone only among men with lower cortisol levels. This research offers empirical evidence of possible evolutionary functions for attention to men’s vocal characteristics in contexts of sexual selection.

Skin-whitening creams: worth the risk?

Findings presented at the European Congress of Endocrinology earlier this year suggest that women who use high-strength corticosteroid creams to lighten their skin may be at risk of adrenal insufficiency. The study involved 90 Egyptian women. The investigators measured baseline cortisol levels for 45 women who had been using corticosteroid-containing creams for at least the previous 3 months and compared them with baseline levels for 45 women who did not use these products. Although overall there was no significant difference between the two groups, the subset of women who used more potent creams, or used the creams more frequently over large areas of their body, had significantly lower baseline cortisol levels than the women in the control group.

Comparing the utility of 30- and 60-minute cortisol levels after the standard short synacthen test to determine adrenal insufficiency: A retrospective cross-sectional study.

Short Synacthen test (SST) involves measuring the baseline, 30-, and 60-minute serum cortisol levels, after injecting 250 μg of synthetic adrenocorticotropic hormone or Synacthen (ACTH). This study aimed to review the current clinical practice of performing SST to establish a standardized test protocol and to additionally test the hypothesis regarding performing the 60-minute cortisol test alone and the dependence of overall SST result on baseline cortisol level.Patients >14 years who underwent SST from January 2010 to December 2017 were included. Pearson's chi-square cross-tabulation was used to identify individuals with inconsistent 30- and 60-minute serum cortisol test results. Logistic regression analysis was performed to predict normal responses based on the baseline cortisol value.Of the 965 patients identified from pharmacy, medical, and laboratory records, 849 were included. Mean baseline, 30-, and 60-minute cortisol levels after ACTH injection were 394 ± 286.58, 722 ± 327.11, and 827 ± 369.30 nmol/L, respectively. Overall, 715 (84%) and 134 (16%) patients had normal and abnormal responses, respectively. Primary and secondary adrenal insufficiency was diagnosed in 10% and 35%, respectively, while ACTH levels were not measured in 55% of the patients. Overall, 9.49% (n = 72) of the patients had a suboptimal response at 30 minutes, but reached the threshold value of 550 nmol/L at 60 minutes. This particular subgroup's mean change (240 nmol/L) in cortisol level from baseline to 30-minute was higher than that observed in patients with abnormal response at both time-points (mean change, 152 nmol/L). No patient with 30-minute optimal responses had 60-minute suboptimal responses. The baseline serum cortisol threshold of ≥226 nmol/L had 80% sensitivity, 71% specificity, and 93% positive predictive value for detecting a normal SST (P-value < .0001).Relying on a 60-minute cortisol level can identify all normal and abnormal responses, while relying on 30-minute cortisol level alone may produce false-positives. Additionally, a baseline cortisol level of ≥226 nmol/L is a reliable threshold for determining adequate adrenal function, particularly with a low pretest hypoadrenalism probability.