Cortisol Assay Research Articles

7247 Adrenal Insufficiency In Advanced Cirrhosis: A ‘Shocky’ Clinical Dilemma

Abstract Disclosure: L. Aboishava: None. A. Pareek: None. A. Mertens: None. A. Erokhin: None. Background: In patients with advanced cirrhosis, profound hypoproteinemia can complicate the laboratory assessment of the hypothalamic-pituitary-adrenal axis, but a clinical phenotype of persistent hypotension and suboptimal cortisol response to ACTH stimulation raises the question of whether adrenal insufficiency could also be a contributing factor. Clinical Case: A 65-year-old man with a history of cirrhosis complicated by esophageal varices, ascites, encephalopathy and hepatorenal syndrome was admitted to the ICU with worsening fatigue, profound hypotension, and respiratory arrest. He was started on pressors, antibiotics and was also intubated for a short time. A broad workup was negative for cardiac or infectious causes of shock and showed decreased total protein and albumin (1.6 g/dl (3.5-5.2), with normal serum sodium and potassium. The patient had no previous history of adrenal disease or corticosteroid use. Workup for adrenal insufficiency was initiated and showed decreased morning blood serum cortisol (10.6 ug/dl (2.5-19.5)) and ACTH (<5.0 pg/ml (7.2-63)), as well as suboptimal cortisol response on ACTH stimulation testing (12.5 ug/dl initially, 16.7 ug/dl after stimulation). Head CT on admission was negative for intracranial pathology, and lab results showed normal TSH and mildly increased prolactin of 36.2 ng/ml (4.0-15.0). Pt was started on IV hydrocortisone 50 mg TID. Glucocorticoid therapy didn’t improve his state significantly but was continued with a gradual tapering down of the dose. After intense treatment in the ICU the patient’s state was stabilized. Unfortunately, an endoscopy performed for worsening anemia and blood in stools showed gastric cancer. The patient was transferred to comfort care after a discussion of goals of treatment and died within the next 24 hours. Conclusion: The nature of decreased cortisol levels in patients with cirrhosis is most likely multifactorial, due to impaired hepatic synthetic function, dysregulation of hormone-binding protein balance, abnormal ACTH secretion, and other factors. Impaired corticosteroid-binding globulin synthesis might affect the ratio of globulin-bound and free hormone fractions and alter the accuracy of cortisol assays. Whether adrenal insufficiency is truly one of the complications of advanced cirrhosis contributing to persistent hypotension, or a mere laboratory finding is difficult to answer. It is also yet to be determined whether patients with advanced cirrhosis might benefit from screening and treatment of adrenal insufficiency in circumstances of persistent hypotension, and studies are needed to decide on optimal diagnostic tests to recognize the disease and develop treatment algorithms. Presentation: 6/3/2024

B-008 An Evaluation of the Analytical Performance of the New Beckman Coulter DxC 500i Clinical Analyzer

Abstract Background The DxC 500i Clinical Analyzer* is Beckman Coulter’s latest integrated Clinical Chemistry and Immunoassay analyzer. It provides reliability, scalability, and workflow efficiency via a flexible independent maintenance mode, increased uptime, and a dynamic sample handler to optimize sample management. Standard Beckman Coulter Chemistry and Immunoassay consumables and reagents ensure network standardization and commutability. The purpose of this study was to evaluate the analytical performance of the new DxC 500i analyzer and to compare the performance against the Beckman Coulter stand-alone Clinical Chemistry and Immunoassay analyzers on the market. Methods To assess performance over a range of assay methodologies, several DxC 500i Beckman Coulter Immunoassays and Chemistry assays were evaluated. Precision was assessed using human samples following CLSI EP05-A3 guidelines. Linear range was assessed following CLSI EP06-A guidelines. Method Comparison and Bias Estimation studies compared the DxC 500i Clinical Analyzer against the Access 2 Immunoassay System, the AU480 and the DxC 700 AU Clinical Chemistry analyzers, following CLSI EP09c-ED3 guidelines. To investigate carryover potential as samples are processed across the integrated system, a carryover study was designed. This focused on evaluating potential sample-to-sample carryover caused by the AU sample probe and its effects on immunoassay samples during reflex scenarios. Results DxC 500i Chemistry results: Glucose Serum (OSR6x21) Assessments of repeatability and within laboratory precision at multiple critical analyte concentrations showed total imprecision of <3% and within-run imprecision of <3%. The Glucose serum assay demonstrated acceptable linearity throughout the 10-800 mg/dL analytical measuring range. Method comparison studies compared the DxC 500i analyzer against the AU480 and DxC 700 AU systems. A Weighted Deming regression of serum patient samples (n>100 measured across the analytical range) yielded a 0.986 slope, 0.227 mg/dL intercept, and R=0.9999 correlation coefficient against the DxC 700 AU and a 0.995 slope, 0.356 mg/dL intercept, and R=0.9999 correlation coefficient against the AU480. DxC 500i Immunoassay results: Cortisol (33600) Beckman Coutler’s Cortisol assay exhibited total imprecision of <12%CV at <5 μg/dL or <10CV% at ≥5 μg/dL for serum. The Cortisol assay demonstrated acceptable linearity throughout the 0.4-60 μg/dL analytical measuring range. A method comparison study compared the DxC 500i against the Access 2 system. A Weighted Deming regression of serum patient samples (n>100 measured across the analytical range) yielded a 0.9785 slope, 0.2764 μg/dL intercept, and R=0.9932 correlation coefficient. DxC 500i Carryover Assessment The Total βhCG (5th IS) assay was used to evaluate the potential of chemistry analyzer to immunoassay analyzer sample carryover. The study used High hCG serum samples (>1,000,000 mIU/mL) and Low hCG serum samples (4-6 mIU/mL). The DxC 500i exhibited a cumulative carryover of ≤2 parts per million (PPM) for serum. Conclusions These studies demonstrate excellent analytical performance for the new Beckman Coulter DxC 500i Clinical Analyzer* and confirm comparable performance to current Beckman Coulter standalone Clinical Chemistry and Immunoassay analyzers on the market. *Pending clearance by the United States Food and Drug Administration; not yet available for in vitro diagnostic use in the U.S. Product availability and regulatory status depends on country registration per applicable regulations.

A-056 Investigating Iodine Contrast Contamination in Cortisol and Aldosterone Samples

Abstract Background Primary aldosteronism (PA) is a condition characterized by hypertension resulting from excess secretion of aldosterone. PA caused by a unilateral aldosterone-producing adenoma can be treated with adrenalectomy but requires diagnosis by adrenal vein sampling (AVS). In this procedure, intravenous cosyntropin is administered to stimulate adrenal cortical secretion, followed by obtaining samples from the right and left adrenal veins and IVC. Laterization index is calculated by obtaining the aldosterone:cortisol ratio for each side, with a ratio cutoff ≥3 is used for confirmation. Iodinated contrast media facilitates visualization of catheter positioning during AVS and sometimes results in contamination of samples, evidenced by abnormal gel separator flotation (i.e. gel above plasma). This study had two aims: 1) to determine at what concentration contrast dye causes gel flotation and 2) discern whether contrast media interferes with our cortisol or aldosterone assays. Methods Gel flotation studies were performed by spiking pooled plasma samples with iohexol contrast media (Omnipaque 240, GE Healthcare) at concentrations ranging from 3%-10% v/v and aliquoting into fresh lithium heparin plasma separator tubes (BD, PSTs). Samples were then centrifuged and visually inspected for abnormal gel flotation. Contrast interference studies were performed using three pools of low (5 µg/dL), medium, (30 µg/dL), and high (55 µg/dL) cortisol concentrations. Sample pools were diluted with 20% contrast media or saline (control) and subsequently mixed at different ratios to create a range of dye concentrations (0.5%-18% v/v). Each mixture was assayed in triplicate for cortisol and aldosterone on a cobas e602 (Roche Diagnostics) and LIAISON XL (DiaSorin) immunoanalyzer, respectively. The total allowable error (TEa) was ±0.4 μg/dL or ±20% for cortisol and ±2 ng/dL or ±20% for aldosterone. Results Flotation of the gel separator was observed at a dye concentration of 4.5% v/v and greater. For the cortisol interference study, the bias was <5% for the three pools at all contrast media concentrations. Aldosterone was also measured in these pools, as bias could affect ratios calculated for PA. Aldosterone interference occurred at contrast dye concentrations ranging from 12%-20% v/v. An average positive bias of 34% was observed in aldosterone samples spiked with contrast media relative to the saline control. Compared to sample pool controls without added saline or dye, measurements for cortisol and aldosterone were 19%-22% and 16-25% lower in media- and saline-spiked samples (20% v/v), respectively, indicating a logical dilution effect. Conclusions Contrast dye contamination of AVS specimens can cause gel flotation in lithium heparin PSTs, preventing their analysis. The presence of contrast media at certain concentrations interfered with the DiaSorin aldosterone assay, leading to falsely elevated results. No cortisol assay interference occurred in the presence of contrast media but results were falsely decreased due to sample dilution. Samples collected during AVS may be contaminated with contrast dye causing gel flotation to occur. This is indicative of a minimum contrast media concentration of 4.5% v/v. Aldosterone:cortisol ratios may be inaccurate due to the positive aldosterone immunoassay bias with contrast media contamination. Care should be taken when reporting and interpreting AVS results with suspected contamination.

Hair cortisol concentrations in clipped and combed hair and associations with characteristics, health status and stress in domestic cats

Hair cortisol concentrations (HCC) are measured to assess long-term HPA-axis activity and may represent a valuable non-invasive tool to evaluate chronic stress in cats. This study investigated combing as a novel, low-stress method for HCC assessment, as well as possible associations between HCC and cat characteristics in 167 owned cats. Hair was sampled at veterinary clinics through clipping and/or combing the cat, or at home by the owner combing the cat. A questionnaire was sent to cat owners, including inquiries about the cat’s sex, health status, and exposure to stress. HCC was quantified using a commercial cortisol assay kit. Despite variations within and between sampling methods, Spearman’s correlation and Bland–Altman plots revealed a moderate correlation between clipped and combed samples (rs = 0.61, LOA -5.51 ± 22.54). In multiple linear regression, variations in HCC were observed based on sex, health status and cat group size. No associations were found between HCC and stress as assessed by owners. Despite study limitations and remaining uncertainty regarding factors influencing HCC, combing presents a convenient approach for evaluating long-term HPA-axis activity in clinical settings. The association between health and HCC suggests alterations in cortisol levels that are related to disease processes and stress-inducing events associated with the disease.

Child temperamental negative affectivity moderates the relation between interparental conflict and child cortisol recovery

AbstractThis study examined the relation between interparental conflict and cortisol recovery, with child temperamental negative affectivity as the moderator. Children (n = 118) ages 9–11 years observed an argument between their parents in the lab and provided saliva samples for cortisol assays. Children also reported levels of interparental conflict, and mothers reported their child's negative affectivity. Results showed that youths with high levels of negative affectivity experienced less cortisol recovery as interparental conflict levels increased. Further, demonstrating some support for differential susceptibility, youths with higher levels of negative affectivity exhibited less recovery at high levels of parental conflict but greater recovery at low levels of parental conflict, compared to peers with lower scores on negative affectivity. We also found that children with low levels of negative affectivity exhibited greater recovery as rates of interparental conflict increased. In summary, this study sheds light on sources of variability in cortisol recovery as it relates to interparental disharmony.

Role of Gut Microbe Composition in Psychosocial Symptom Response to Exercise Training in Breast Cancer Survivors (ROME) study: protocol for a randomised controlled trial

IntroductionBreast cancer survivors have an increased risk for chronic fatigue and altered gut microbiota composition, both with negative health and quality of life affects. Exercise modestly improves fatigue and is...

Adrenal Vein Sampling: Tips and Tricks.

Adrenal vein sampling (AVS) is the standard method for distinguishing unilateral from bilateral sources of autonomous aldosterone production in patients with primary aldosteronism. This procedure has been performed at limited specialized centers due to its technical complexity. With recent advances in imaging technology and knowledge of adrenal vein anatomy in parallel with the development of adjunctive techniques, AVS has become easier to perform, even at nonspecialized centers. Although rare, anatomic variants of the adrenal veins can cause sampling failure or misinterpretation of the sampling results. The inferior accessory hepatic vein and the inferior emissary vein are useful anatomic landmarks for right adrenal vein cannulation, which is the most difficult and crucial step in AVS. Meticulous assessment of adrenal vein anatomy on multidetector CT images and the use of a catheter suitable for the anatomy are crucial for adrenal vein cannulation. Adjunctive techniques such as intraprocedural cortisol assay, cone-beam CT, and coaxial guidewire-catheter techniques are useful tools to confirm right adrenal vein cannulation or to troubleshoot difficult blood sampling. Interventional radiologists should be involved in interpreting the sampling results because technical factors may affect the results. In rare instances, bilateral adrenal suppression, in which aldosterone-to-cortisol ratios of both adrenal glands are lower than that of the inferior vena cava, can be encountered. Repeat sampling may be necessary in this situation. Collaboration with endocrinology and laboratory medicine services is of great importance to optimize the quality of the samples and for smooth and successful operation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Comparative Study on the Effect of Bacopa monniera and Omega3 Fatty Acids on the Cortisol Hormone Level in Cold Stress Induced Wistar Albino Rats

In recent years, researchers have identified several natural compounds that could potentially help to retard mental stress. Extracts of Bacopa monniera (BM), a traditional ayurvedic medicine and omega3 faffy acids (OFA) have been reported to enhance effects mental functions by combating the stress. However, there is still an lacunae studies on which of those two drugs has better results on cortisol hormonal changes due to stress. The current study aimed to compare the effects of BM and omega3 fatty acids on cold stress induced Wistar rats. We divided the animals into seven groups. Group I was control in which rats were kept under ideal laboratory conditions, Group II was given cold water swim stress for a period of one month after which the rats were sacrificed for hormonal assay, Group III in which cold water swim stress given for a month followed by oral administration of normal saline as vehicle for a month, Group IV and V in which cold water swim stress given for a month followed by oral administration of BM extracts 40mg/kg and 80mg/kg respectively as treatment for a month. Group VI and VII includes cold stress followed by oral gavages of OFA 60mg/Kg of Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) for 2 weeks (short-term model) and 4 weeks (long term model) respectively. After the treatment period blood was collected and cortisol assay was done. The data were compared with those of control rats. The results showed an increase in the cortisol level in the stressed group of rats when compared to the treatment group. These results indicate that oral administration of high dose of BM and long-term administration of OFA improves the cortisol level and helps in controlling the stress in rats.

Effect of Bacopa monniera on the Level of Cortisol Hormone in Forced Cold Water Swim Stress Induced Wistar Albino Rats

The human brain remains a mystery even after years of research into the biological processes underlying its specific actions. In recent years, researchers have identified several natural compounds that could potentially help to retard mental deterioration. Extracts of Bacopa monniera, a traditional ayurvedic medicine, have been reported to have memory-enhancing effects in animals. However, there are no studies on bp in cold stress induced neuronal changes in hippocampus have been explored. The current study examined the effects of standardized extract of Bacopa monniera, on Wistar rats. We divided the animals into 4 groups. Group I was control in which rats were kept under ideal laboratory conditions, Group II was given cold water swim stress for a period of one month after which the rats were sacrificed for histological studies to study the changes in the hippocampus caused by cold stress, Group III in which cold water swim stress given for a month followed by oral administration of normal saline as vehicle for a month, Group IV in which cold water swim stress given for a month followed by oral administration of Bacopa monniera, extracts 40mg/kg treatment for a month. Group V in which cold water swim stress given for a month followed by oral administration of Bacopa monniera, extracts 80mg/kg treatment for a month. After the treatment period blood was collected and cortisol assay was done. The data were compared with those of control rats. The results showed an increase in the cortisol level in the stressed group of rats when compared to the treatment group. These results indicate that oral administration of Bacopa monniera, extract improves the cortisol level and helps in controlling the stress in rats.

Large litters have a detrimental impact on litter performance and postpartum maternal behaviour in primiparous sows

BackgroundOur previous study confirmed that large litter size adversely affects prepartum maternal hormones and behaviour, concurrently with heightened oxidative stress in primiparous sows. The purpose of this study was to examine the effect of large litter size on litter performance, postpartum maternal behaviour, salivary cortisol levels, and colostral immunoglobulin levels in sows, as well as investigate their correlations with the levels of oxidative stress parameters.ResultsA total of 24 primiparous sows (Landrace\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \ imes $$\\end{document}Large white) and their offspring were categorised into two groups based on litter size: NORMAL (n = 8) with litter size ranging from 7 to 14 (mean 11.5\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\pm $$\\end{document}2.7), and LARGE (n=16) with litter size ranging from 15 to 20 (mean 15.9\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\pm $$\\end{document}1.4). All sows were housed in a group housing system during gestation and transitioned to an adaptable loose housing system (2.4\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \ imes $$\\end{document}2.3 m) during the farrowing and lactation periods. The nursing and carefulness behaviour of the sows was monitored over a 24-h period between 72 and 96 h after parturition. Saliva samples were collected for cortisol assay on 35, 21, and 7 days before parturition (D-35, D-21, and D-7, respectively), as well as on days 1, 7, and 28 after parturition (D1, D7, and D28, respectively). On D1, higher piglet mortality rates were observed among the LARGE group compared to the NORMAL group (p<0.01). The total and successful nursing behaviours of the sows were less frequent in the LARGE group than in the NORMAL group (p<0.05, for both), and the carefulness score of the LARGE group was also lower than that of the NORMAL group (p< 0.01). On D1, cortisol levels in LARGE sows were higher than those in NORMAL sows (p< 0.05), and for other time points (D-21, D-7, D7, and D28), cortisol levels in LARGE sows tended to be higher than those in NORMAL sows (p < 0.10, for all). Successful nursing behaviour displayed negative correlations with levels of salivary cortisol and certain oxidative stress parameters measured on D1.ConclusionsThese findings suggest that the strategy for alleviating physiological and oxidative stress during the peripartum periods could benefit potential postpartum maternal behaviour and litter performance in the sows with large litters.

Postpartum symptoms of anxiety, depression and stress: differential relationships to women’s cortisol profiles

PurposeWomen are at high risk of stress, anxiety, and depression during the postpartum but the ways in which these different types of psychological distress are related to cortisol regulation is not clear. We examined the distinct association of each type of distress with women’s average cortisol level, cortisol awakening response (CAR), cortisol decline across the day (diurnal slope), and overall amount of cortisol secretion across the day (AUCG).MethodsAt 6 months postpartum, a diverse group of 58 women completed measures of depression, anxiety, perceived stress, and life stressors. Each woman provided 4 salivary samples for cortisol assay from waking to bedtime on each of 2 consecutive days. Linear regressions were used to examine associations of stress, anxiety and depression to each of the 4 cortisol measures, controlling for number of stressful life events.ResultsDepressive symptoms were associated with less of a rise in the CAR (β = -.46, p = 0.01), steeper diurnal slope (β = .51, p = 0.006), and higher average cortisol level (β = .42, p = .01). Women who met the clinical cutoff for an anxiety disorder had lower overall cortisol output (β = -.29, p = 0.03). Stress was not related to any cortisol metric.ConclusionsFindings suggest that stress is less associated with cortisol alterations in the postpartum than are more severe types of psychological distress. Anxiety and depression may have distinct and opposite profiles of cortisol dysregulation. Results indicate that mental health assessment is critical even in the later postpartum so that interventions can be initiated to reduce emotional suffering and the risk of impaired cortisol regulation.

Prediction of adrenal insufficiency after pituitary surgery: a retrospective study using beckman access cortisol assay.

Identifying patients requiring glucocorticoid replacement therapy after pituitary surgery is challenging as the tests commonly used for the diagnosis of secondary adrenal insufficiency (SAI) are not recommended in the immediate postoperative period. There are controversial data on the role of postoperative days' morning cortisol, with no specific data for each cortisol assay. The aim of this study is to investigate the reliability of 8.00 a.m. cortisol of the first and second postoperative days in predicting SAI. Data of patients underwent pituitary surgery in Humanitas Research Hospital in Italy, from March 2017 to August 2022, were retrospectively analyzed. Definitive diagnosis of SAI was made through ACTH test 1µg six weeks after surgery. Cortisol was measured through Beckman Access Cortisol and the diagnosis of SAI was made if cortisol peak was below 14.8µg/dL (408 nmol/L) at 30 or 60min after stimulus. Of the sixty-four patients enrolled, seven developed SAI. The ROC curves demonstrated that both first- and second-day postoperative 8.00 a.m. cortisol predict SAI (AUC 0.94 and 0.95, respectively). The optimal thresholds were 15.6µg/dL (430.3 nmol/L; accuracy 89%) for the first day and 11.5µg/dL (317.2 nmol/L, accuracy 81%) for the second day. Patients who developed SAI had larger tumors (p = 0.004) and lower fT4 (p = 0.038) before surgery. Clinicians might rely on the first- and second- postoperative days 8.00 a.m. cortisol to identify patients to discharge with glucocorticoid replacement therapy waiting for the confirmation of SAI through the ACTH test.

A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling

This study assessed the clinical performance of point-of-care testing (POCT) for quick cortisol assay (QCA) during adrenal vein sampling (AVS) using a newly invented portable quantitative assay instrument. An observational study was conducted prospectively at two centres in Japan. Forty-eight patients with primary aldosteronism considered for adrenalectomy were enrolled in this study and underwent AVS. Three basal adrenal vein samples from each adrenal vein and two from the inferior vena cava were collected sequentially. The cortisol concentration of adrenal vein samples was measured by routine method and QCA. A total of 338 adrenal vein samples were analysed from 250 sites to determine AVS success or failure. The distribution of turnaround time of the QCA for AVS success or failure followed a normal distribution with an average of 20.5 min. A positive correlation between the routine method and QCA was observed regarding cortisol concentration or selectivity index. No significant difference between the two methods was observed regarding the success rate of AVS. Using the routine method as a reference, the sensitivity and specificity of AVS success or failure were 99.1% (210/212) and 81.6% (31/38), respectively. Easy, quick, portable, and precise POCT-QCA demonstrated its compatibility with routine methods regarding clinical performance.

Developmental toxicity and neurobehavioral effects of sodium selenite and selenium nanoparticles on zebrafish embryos

Selenium, a trace mineral, is essential for several physiological processes in humans and animals. It is an antioxidant vital for the immunological response, DNA synthesis, thyroid hormone metabolism, and antioxidant defense enzymes. Zebrafish embryos and larvae were exposed to different concentrations of sodium selenite (SodSe) and selenium nanoparticles (SeNs) at various developmental stages. The study evaluated the impact of SodSe and SeNs on larvae survival, hatching rate, and morphological abnormalities. Also, acridine orange staining was used to analyze the apoptotic cell death, and behavioral tests were conducted to assess anxiety-like behaviors. The results showed that both SodSe and SeNs influence the development and neurobehavior of zebrafish larvae in a concentration-dependent manner. SodSe at high concentration causes low survival rates, delayed hatching, and increased morphological defects in zebrafish larvae. In addition, exposure to SodSe resulted in elevated apoptosis in different larval tissues. Zebrafish larvae treated with SodSe and SeNs exhibited anxiety-like behaviour, increased thigmotaxis, less exploratory behaviour, and less swimming patterns. The nerve conductions and stimuli responses evaluated through acetylcholine esterase (AChE) and cortisol assays, revealed a decrease in the activity in a dose-dependent manner of SodSe and SeNs. Interestingly, the effects of SeNs were lower even at higher concentrations when compared with SodSe at lower concentrations on zebrafish embryos. This shows that SeNs synthesized through biological methods may be less toxic and may have lower effect on the development and neurobehavior of zebrafish larvae. Thus, our study confirms the cytotoxic and neurobehavioral effects of SodSe and suggests the use of SeNs at lower concentration to provide insights into better understanding of developmental stages and metabolic pathways in zebrafish larvae.

Relationships Among Number of Stressors, Perceived Stress, and Salivary Cortisol Levels During the Third Trimester of Pregnancy

ObjectiveTo examine relationships among the number of stressors, perceived stress, and salivary cortisol levels during the third trimester of pregnancy. DesignSecondary analysis of cross-sectional data. SettingParticipants’ homes. ParticipantsWomen during the third trimester of pregnancy (N = 73). MethodsParticipants provided saliva samples at four time points over 2 days for cortisol assay and completed questionnaires to assess stressors and perceived stress. We computed multiple linear regression models to examine the relationships among the number of stressors and perceived stress to cortisol awakening response, diurnal slope, and overall cortisol secretion. We also computed a multiple linear regression model to examine the relationship between perceived stress and the number of stressors. ResultsGreater perceived stress was associated with reduced overall cortisol secretion across the day (β = −0.41, p = .01). The number of stressors was associated with perceived stress (β = 0.48, p = .002) but not salivary cortisol measures. ConclusionElevated perceived stress and the related cortisol alterations that we identified could represent salient targets for enhancing hypothalamic-pituitary-adrenal axis function during the third trimester. Perceived stress may shape the relationship between exposure to stressors and cortisol response during pregnancy. Future research is warranted to confirm study results and to understand the implications for parturition and fetal development.

Peak Serum Cortisol Cutoffs to Diagnose Adrenal Insufficiency Across Different Cortisol Assays in Children

Current peak serum cortisol cutoffs for the diagnosis of adrenal insufficiency (AI) after Cosyntropin stimulation have been established using polyclonal antibody (pAb) immunoassays. However, new and highly specific cortisol monoclonal antibody (mAb) immunoassays are being used more widely, which can potentially yield higher false positive rates. Thus, this study aimed to redefine the biochemical diagnostic cutoff points for AI in children when using a highly specific cortisol mAb immunoassay and liquid chromatography tandem mass spectrometry (LC/MS) to avoid unnecessary steroid use. Cortisol levels from 36 children undergoing 1 mcg Cosyntropin stimulation tests to rule out AI were measured using pAb immunoassay (Roche Elecsys Cortisol I), mAB immunoassay (Roche Elecsys Cortisol II), and LC/MS. Logistic regression was used to predict AI using the pAB as the reference standard. A receiver operator characteristic curve, area under the curve (AUC), sensitivity, specificity, and kappa agreement were also calculated. Using a peak serum cortisol cutoff value of 12.5 μg/dL for the mAb immunoassay provided 99% sensitivity and 94% specificity for diagnosing AI, when compared to the historical pAb immunoassay cutoff of 18 μg/dL (AUC=0.997). Likewise, a cutoff of value of 14 μg/dL using the LC/MS, provided 99% sensitivity and 88% specificity when compared to the pAb immunoassay (AUC=0.995). To prevent overdiagnosis of AI in children undergoing 1 mcg Cosyntropin stimulation test, our data support using a new peak serum cortisol cutoff of 12.5 μg/dL and 14 μg/dL to diagnose AI when using mAb immunoassays and LC/MS in children, respectively.

Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use.

Co-use of cannabis is increasing in nicotine users and presents additional challenges in addressing nicotine dependence. This study examined the links between regular co-use of cannabis and nicotine with biobehavioral and affective changes in response to stress during nicotine withdrawal and ad libitum use. Participants (N = 79) who regularly used nicotine-only, cannabis-only, both substances, or neither substance were invited to attend two laboratory stress assessment sessions. For nicotine users, one session occurred during ad libitum nicotine use and one occurred after abstinence from nicotine. During the stress sessions, participants provided saliva samples for cortisol assay and completed measures of subjective states. Cardiovascular measures were collected during resting baseline, exposure to acute stressors, and a recovery rest period. Nicotine-only users had higher average cortisol levels in the second lab session (nicotine withdrawal) relative to the first lab session (ad libitum nicotine use). Compared to nicotine non-users, nicotine users reported less positive affect and exhibited attenuated cortisol and systolic blood pressure (BP) stress responses. Cannabis users exhibited exaggerated diastolic BP responses to stress compared to cannabis non-users, and co-users of nicotine and cannabis had higher levels of cannabis craving than cannabis-only users (p < .01). This study partially replicated earlier findings on the effects of chronic nicotine use and provided novel results regarding the influence of cannabis co-use on physiological and affective responses to stress in nicotine users during nicotine withdrawal.

Testosterone promotes dominance behaviors in the Ultimatum Game after players’ status increases

Although testosterone is generally considered to promote dominance behaviors, in humans it fosters behaviors appropriate to achieving and maintaining social status, contingent upon the situation. Recent cross-sectional studies, such as Inoue et al. (Sci Rep 7:5335, 2017), have shown that dominance behaviors induced by testosterone are modulated by high status. Yet, it remains ambiguous whether a rise in social status within real-world social groups reshapes the relationship between testosterone and dominance behavior. To investigate this longitudinal question, we added a second wave to Inoue et al.’s study, collecting further data after an interval of 2 years. Members of a university rugby team that adheres to a rigid hierarchical order rooted in seniority played the Ultimatum Game with teammates and provided saliva for assays of testosterone and cortisol. Our analysis reveals that individuals with higher baseline salivary testosterone levels exhibited more dominance as their position in the hierarchy increased according to their seniority.

A population-based study of children suggests blunted morning cortisol rhythms are associated with alterations of the systemic inflammatory state

BackgroundIn children, digital media, lifestyle, and the COVID pandemic have impacted sunlight exposure, exercise, and diet patterns - cues that entrain the circadian clock. We hypothesized that low morning cortisol reflects a weak circadian clock, impacting the pro-inflammatory state. The primary objective was to test relationships between diurnal cortisol fluctuations and the inflammatory state in children as a means of providing indirect support for this hypothesis. MethodsThe Cardiovascular Health Intervention Program (CHIP) was a population-based cross-sectional and longitudinal study of circadian health in public elementary school children in Southern Maine, USA (recruitment period 2012–2017). Participants were 689 students in 4th grade (baseline; age=9.2 ± 0.4 years), and 647 students in 5th grade (age=10.5 ± 0.5 years). Nine salivary cortisol measures per child (2 awakening and 1 prior to bed for 3 sequential days) (n = 1336 child phenotype days; n = 7987 cortisol assays), 10 cytokines measured in morning and evening saliva samples (n = 202 child phenotype days), and lipids were measured. Clinical outcomes were blood pressure, weight and height (body mass index [BMI]; BMI = kg/m2), among others. FindingsUpon-waking cortisol levels were 0.28 ± 0.13 µg/dL, 30-minute post-waking 0.33 ± 0.15 µg/dL, and evening 0.08 ± 0.10 µg/dL. Salivary cytokine levels (n = 202) showed interleukins (IL) IL-1β and IL-8 were highest in early morning (upon awakening; AM), and IL-6 and tumor necrosis factor (TNF) TNF-α highest before bed (PM) (IL-1β AM > PM [−4.02 fold; p < 0.001]; IL-8 AM > PM [−1.36 fold; p < 0.001]; IL-6 AM < PM [+1.49 fold; p < 0.001]; TNF-α AM < PM [+1.73 fold; p = 0.03]. Regression modeling showed high morning cortisol was associated with high morning IL-1β (p = 3.82 ×10−6), but low evening IL-1β (p = 6.27 ×10−4). Regression modeling of BMI z-score as the response variable showed the expected significant relationships to high density lipoprotein (HDL) (negative; p < 0.001), mean arterial pressure (positive; p < 0.001), and morning cortisol (negative; p = 0.01) but only weak relationships to either evening cortisol (p = 0.1) or cytokine (positive; p = 0.02; from the model with smallest Rsquared) levels. InterpretationWe provide preliminary data on diurnal fluctuations of inflammatory cytokines in saliva in a population-based cohort of children. Correlation of morning and evening cortisol levels with inflammatory cytokines in the same saliva samples showed that high morning cortisol was associated with high morning IL-1β and low evening IL-1β. Future studies may test the hypothesis that strong diurnal cycling of IL-1β may serve as a homeostatic mechanism keeping the immune system in check, and that low morning cortisol (possible circadian misalignment) may lead to less stringent control of inflammatory networks.

The cortisol levels in the follicular and luteal phases of the healthy menstruating women: a meta-analysis.

The conflicting results of the previous studies regarding the serum cortisol through the menstrual cycle warranted further research. We aimed to detect the cortisol levels in the follicular and luteal phases of healthy menstruating women. A literature search was conducted by two independent authors according to PRISMA criteria over PubMed, Web of Science and Psych-Info to retrieve the articles published in English from 1990 until 2020 and containing the keywords, Cortisol, Menstrual, Follicular, or Luteal. The quality assessment of the articles/studies was done using the CONSORT and STROBE checklists. The risk bias was assessed by two independent authors using Cochrane risk-bias assessment tool. Twenty-eight (28) articles were included in this meta-analysis. The cortisol levels were significantly higher in the studied-participants' follicular phase compared to the luteal phase (p<0.01). The cortisol levels sub-analysis showed a significant effect of plasma cortisol over the salivary cortisol (p=0.04). The cortisol assay time showed a significant effect of the morning cortisol over the afternoon cortisol (p=0.005). This meta-analysis found the cortisol levels were significantly higher in the studied-participants follicular phase compared to the luteal phase. The cortisol sub-analysis showed a significant effect of plasma and morning cortisol over the salivary and afternoon cortisol, respectively.