Depression Cortisol Research Articles

Assessing the Role of Cortisol in Anxiety, Major Depression, and Neuroticism: A Mendelian Randomization Study Using SERPINA6/SERPINA1 Variants

BackgroundPrevious evidence informed by the toxic stress model suggests that higher cortisol causes anxiety and major depression, but clinical success is lacking. To clarify the role of cortisol, we used Mendelian randomization to estimate its associations with anxiety, major depression, and neuroticism, leveraging the largest available genome-wide association studies including from the Psychiatric Genomics Consortium, the UK Biobank, and FinnGen. MethodsAfter meta-analyzing 2 genome-wide association studies on morning plasma cortisol (n = 32,981), we selected single nucleotide polymorphisms (SNPs) at p < 5 × 10−8 and r2 < 0.3 in the SERPINA6/SERPINA1 gene region encoding proteins that influence cortisol bioavailability. We applied these SNPs to summary genetic associations with the outcomes considered (n = 17,310–449,484), and systolic blood pressure as a positive outcome, using inverse-variance weighted meta-analysis accounting for correlation. Sensitivity analyses addressing SNP correlation and confounding by childhood maltreatment and follow-up analyses using only SNPs that colocalized with SERPINA6 expression were conducted. ResultsCortisol was associated with anxiety (pooled odds ratio [OR] 1.16 per cortisol z score; 95% CI, 1.04 to 1.31), but not major depression (pooled OR 1.02, 95% CI, 0.95 to 1.10) or neuroticism (β −0.025; 95% CI, −0.071 to 0.022). Sensitivity analyses yielded similar estimates. Cortisol was positively associated with systolic blood pressure, as expected. Using rs9989237 and rs2736898, selected using colocalization, cortisol was associated with anxiety in the UK Biobank (OR 1.32; 95% CI, 1.01 to 1.74) but not with major depression in FinnGen (OR 1.14; 95% CI, 0.95 to 1.37). ConclusionsCortisol was associated with anxiety and may be a potential target for prevention. Other targets may be more relevant to major depression and neuroticism.

Abstract 16226: Stressed Out - When Sinus Bradycardia is Not Benign

Background Sinus bradycardia is often a benign and asymptomatic finding in athletes due to an increased vagal tone. However, when patients develop symptoms of decreased exercise tolerance, this warrants further investigation. We present a case of sinus bradycardia caused by adrenal insufficiency in a high-end athlete with exceptional physical reserve which resolved with treatment of the underlying cause and prevented unnecessary pacemaker implantation. Case Presentation A 44-year-old female athlete with no medical history who at baseline runs ultramarathons and weight lifts presented with severely symptomatic bradycardia. After initial recommendation of pacemaker placement during recent hospitalization, patient sought a second opinion. During her hospitalization, the patient underwent extensive work up including basic laboratory work, TSH, CT angiogram of the chest and TTE - all of which were found to be normal. She also had an exercise stress test and was only able to increase her HR to 50% of age-predicted rate. On further review, she was found to be hypothermic and reported menstrual irregularities, raising suspicion for endocrine abnormalities. Bradycardia, hypothermia and chronotropic incompetence prompted further workup which revealed a depressed cortisol with a low ACTH leading to a diagnosis of adrenal insufficiency. Further imaging revealed a pituitary microadenoma. The patient was referred to endocrinology and started therapy with steroids with resolution of her symptoms and is undergoing evaluation for surgical intervention. Conclusion Sinus bradycardia is a well-recognized occurrence in well trained athletes, caused by an increased vagal tone and is usually a benign finding. In our case, a patient underwent extensive work up for lightheadedness and exercise intolerance in the setting of her bradycardia which was unrevealing with initial recommendation of pacemaker placement. Upon further investigation, increased vagal tone alone was not responsible for severely symptomatic bradycardia and chronotropic incompetence. Notably, a combination of bradycardia, hypothermia, and irregular menses, resulted in work up revealing adrenal insufficiency, ultimately avoiding unnecessary pacemaker implant.

Gender Differences in Cortisol and Cortisol Receptors in Depression: A Narrative Review.

Stress is known to have a significant impact on mental health. While gender differences can be found in stress response and mental disorders, there are limited studies on the neuronal mechanisms of gender differences in mental health. Here, we discuss gender and cortisol in depression as presented by recent clinical studies, as well as gender differences in the role of glucocorticoid receptors (GRs) and mineralocorticoid receptors (MRs) in stress-associated mental disorders. When examining clinical studies drawn from PubMed/MEDLINE (National Library of Medicine) and EMBASE, salivary cortisol generally showed no gender correlation. However, young males were reported to show heightened cortisol reactivity compared to females of similar age in depression. Pubertal hormones, age, early life stressors, and types of bio-samples for cortisol measurement affected the recorded cortisol levels. The role of GRs and MRs in the HPA axis could be different between males and females during depression, with increased HPA activity and upregulated MR expression in male mice, while the inverse happened in female mice. The functional heterogeneity and imbalance of GRs and MRs in the brain may explain gender differences in mental disorders. This knowledge and understanding will support the development of gender-specific diagnostic markers involving GRs and MRs in depression.

Associations in time between salivary cortisol and emotions in depressed patients and controls

IntroductionDepression can be understood as a complex dynamic system, where depressive symptoms can directly affect each other. Knowledge on this symptom-symptom interaction is still scarce and is likely to differ between individuals. The hypothalamic-pituitary-adrenal (HPA) axis is often implicated in depression, with hypercortisolism and impaired glucocorticoid receptor-mediated feedback inhibition being commonly reported. High salivary cortisol levels may reflect a reaction to symptoms, or may rather be a cause, effectively ‘binding’ symptoms.ObjectivesWe aimed to analyze the temporal interplay between salivary cortisol and emotions in depressed patients and controls by using the novel Dynamic Time Warp analysis (DTW) approach.MethodsThe ‘Mood and movement in daily life’ (MOOVD) study consisted of 30 pair-matched (15 depressed and 15 control) participants. Salivary cortisol was collected three times a day for 30 days, resulting in 90 measurements per individual. At the same moments, participants completed questionnaires on an electronic diary, which included different momentary positive (PA) and negative (NA) affect items. The dynamic interplay between salivary cortisol and affect were analyzed by DTW, which extends momentarily associations to include one earlier and one later time point, in both undirected and directed analyses.ResultsIndividual networks differed substantially within groups. At the group level, undirected and directed network analyses showed differences between depressed patients and controls. In undirected analysis, connectivity of PA items was comparable between depressed patients and controls, but the NA items showed a less dense network in depressed patients. Directed DTW analyses indicated (p = 0.07) that increases in salivary cortisol preceded that of some NA items (e.g., tiredness) in controls, but tended to follow upon NA item increase (e.g., not feeling appreciated) in depressed patients.ConclusionsAt the group level, connectiveness between NA items was substantially weaker in depressed patients compared to controls. As in complex systems strong internal connectivity facilitates “critical transitions” to different states, this may reflect (or explain) the persistence of a chronically depressed state. We preliminary conclude that high salivary cortisol in depression may be a consequence of NA, rather than a cause. Replication of these first exploratory findings are needed.Disclosure of InterestNone Declared

여성의 스트레스, 불안, 우울과 타액 코티졸 수준과의 관련성

여성의 스트레스, 불안, 우울과 타액 코티졸 수준과의 관련성

Evaluation of Association between Perceived Stress, Anxiety, Depression, Salivary Alpha-Amylase and Salivary Cortisol with Chronic Periodontitis

Introduction: Chronic Periodontitis is a multifactorial inflammatory disease, which is caused by certain series of bacteria in oral biofilm and leads to teeth supporting tissue destruction. Stress, depression and anxiety can affect periodontium health through variable different mechanisms. Cortisol is secreted from adrenocorticotropic glands in pituitary gland and can be used as index to determine psychological stress rate. Alpha-amylase is an salivary gland enzyme which is regulated through sympatric nervous system. The aim of the following study is to compare between different biomarkers related to the emotional stress, anxiety and depression in saliva and their role on periodontal health and also the correlation between periodontal parameters, stress, depression and anxiety. Method: 90 patients with age ranged from 35 to 45 years were participated in the study. Salivary cortisol and alpha-amylase levels were measured in them. Levels of Stress, Anxiety and Depresion were evaluated using questionnaires. The relationship between psychological and biochemical factors with chronic Periodontitis were assessed. The results were analyzed by statistical analysis. Results: The mean concentration of salivary cortisol was 7.87±4.37 ng/ml in the case group and 4.33±2.11 ng/ml in the control group. The difference was statistically significant (p&lt;0.001). The mean concentration of salivary alphaamylase was 3569.27±101.22 U/L in the case group and 3343.44±171.09 U/L in the control group. The difference was statistically significant (p&lt;0.001). The mean stress score was 24.28±3.09 in the case group and 22.96±3.61 in the control group. The difference between two groups was statistically significant (p&lt;0.001). The difference between two groups was statistically significant (p&lt;0.001). The mean anxiety score was 44.11±4.59 in the case group and 36.47±4.30 in the control group, which was statistically significant (p&lt;0.001). The mean depression score was 19.96±3.58 in the case group and 13.13±3.91 in the control group. The difference between two groups was statistically significant (p&lt;0.001). Conclusion: The findings of these study showed that psychological factors like emotional stress, depression and anxiety and biochemical factors including salivary cortisol and alpha-amylase are higher in patients with moderate to severe chronic periodontitis in comparison to healthy people. also Anxiety and depression are stronger predictors of periodontitis than acute stress and cortisol.

Association of Obesity with Depressive Symptomatology, Eating Habits, Interleukin-8 and Cortisol in a Young Population

ABSTRACT Obesity is the result of a complex combination of psychological, biological, and environmental factors. In this work, we evaluate whether obesity is related to eating habits, depressive symptomatology, as well as interleukin-8 and cortisol. A descriptive cross-sectional study was carried out in 232 university students. All youths were surveyed to determine their eating habits and depressive symptomatology. Anthropometric measures and a blood sample were taken to determine its biochemical profile and its concentration of interleukin-8 and cortisol. The results show that interleukin-8 increase in the overfat group. The altered eating behaviors were frequent in the studied group; they were associated with the presence of obesity and the variation of interleukin-8 and cortisol. Besides, we found correlations of interleukin-8 with age, glucose, and lipid profile in the overfat group. In conclusion, these results indicate that high adiposity is related to changes in the concentrations of interleukin-8 and eating habits, confirming that obesity is the consequence of a complex network of various factors.

Epinephrine and Cortisol in Depression

Epinephrine and Cortisol in Depression

Circulating leptin, cortisol and gender differences associated with anorexia or obesity in depression

Objectives: To assess the role of circulating cortisol and leptin in depression associated with anorexia or obesity.Methods: Two hundred and fifty depressed patients presenting to the outpatient clinic of a psychiatric hospital and 250 non-depressed healthy volunteers were included in the study. The subjects of both groups were sub-grouped based upon their gender and BMI. Serum cortisol and leptin were determined by using respective ELISA kits.Results: The number of depressed than non-depressed subjects was three-fold higher in obese BMI groups of both genders. There were more depressed than non-depressed subjects in the underweight male BMI groups and in the overweight female BMI groups. There was a BMI-related increase in serum leptin and a decrease in serum cortisol in both genders. Depression in underweight BMI groups of both genders was associated with a decrease in serum leptin and an increase in cortisol. Higher serum leptin in obese BMI group was associated with a decrease in serum cortisol.Conclusions: Obesity is a risk factor for depression. The shift from typical to atypical depression is due to an inhibitory effect of higher circulating leptin on HPA axis activity and subsequent decrease in the lipolytic effects of cortisol.

The Link between Activities of Daily Living and Cortisol in Late-Life Depression

ABSTRACT Objectives Dysregulated cortisol in older individuals is associated with neurodegeneration and executive dysfunction, among other negative health outcomes. Executive functioning deficits are believed to underlie declines in functioning among older adults. Despite these associations, there is limited research examining the relationship between cortisol and impaired functional status. Methods The present study examined the relationship between cortisol and functional status in a community sample of 51 older adults with depression. Pearson correlations and ordinal regressions were used to determine whether greater cortisol dysregulation was associated with ADL and IADL impairment. Results Results indicated that individuals who had higher levels of cortisol also tended to demonstrate greater functional deficits. These findings remained true when functional status was measured by either a clinician-rated tool or a self-report measure. Conclusions The results of this study provide preliminary support for the hypothesis that elevated cortisol, in the context of depression, is associated with functional status deficits in older adults. Clinical Implications Findings from this study begin to fill the gap in research examining the relationship between cortisol and functional impairment in older adults and suggest that unique information can be gathered with the use of different functional status measures.

Application of language intervention in the regulation of psychological stress during endoscopic retrograde cholangiopancreatography examination

Objective To investigate the application effect of language intervention in the regulation of psychological stress of patients during endoscopic retrograde cholangiopancreatography (ERCP) examination. Methods A total of 70 ERCP patients in Yiwu Central Hospital from April 2013 to May 2017 were included in the study using simple stratified sampling method. A number of 35 cases from April 2013 to April 2015 were recruited as the control group and received routine health education. Another 35 cases from May 2015 to May 2017 were included in the observation group who received additional language intervention. The heart rate, blood pressure, Self-Rating Anxiety Scale (SAS) score, Self-Rating Depression Scale (SDS) score, blood glucose and cortisol levels of patients at different time points were compared between two groups. Results The time factor and between group factor of heart rate, blood pressure, blood glucose and cortisol levels of patients had interaction effect (P<0.05) . The scores of SAS and SDS in the observation group were lower than the scores before the examination, and the differences were statistically significant (P<0.05) . After the examination, there were statistically significant differences in the SAS and SDS scores between two groups (P<0.05) . Conclusions The application of language intervention during the ERCP examination can significantly improve the psychological stress state of patients and the safety of ERCP. Key words: Anxiety; Depression; Blood pressure; Blood glucose; Cortisol; Language intervention; Endoscopic retrograde cholangiopancreatography

Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV+ Women Following a Stress Management Intervention

ABSTRACTObjective: The burden of sleep disturbance and depressive symptomology is high for persons living with HIV and particularly so for women. While cognitive behavioral stress management (CBSM) is shown to reduce symptoms of depression and 24-hr urinary free cortisol output (CORT) in HIV+ men, less is known about the effects of CBSM on mood and concomitant sleep disturbance in HIV+ women. The study aim is to model longitudinal change in sleep disturbance, depressive symptomology, and CORT for HIV+ women exposed to a 12-week CBSM intervention or control condition. Methods: Self-reported sleep quality and depressive symptomology, along with CORT, was collected from surveys at baseline and approximately every three months thereafter for nine months from 130 HIV+ women (Mage = 38.44, SD = 7.73). The data was used to specify a parallel process latent growth model with CORT as a time-varying covariate. Results: The model showed acceptable fit. There was a linear decline in sleep disturbance (β = −0.32, p < .05) and logarithmic decline in depressive symptomology (β = −0.33, p < .05) for those receiving the intervention. Decline in sleep disturbance predicted lower CORT at nine months. Furthermore, having less depressive symptoms at baseline was associated with lower initial levels of sleep disturbance and greater improvement in sleep quality over time. There was no discernible association between sleep and mood disturbance in the control group. Across groups, there was a consistent association between older age and greater sleep disturbance (r = 0.34, p < .01). Conclusion: Sleep disturbance appears to be a behavioral target for CBSM in HIV+ women although older age, preintervention levels of depressive mood, and time-varying levels of CORT output may limit improvement in sleep quality over time.

An iPod-based adaptation of MBSR for lung cancer: Associations of usage with depression and behavioral and endocrine circadian markers

Depressive symptoms are common in lung cancer. In turn, depression and disrupted circadian rhythms predict early mortality in several cancer types, including lung cancer. Mindfulness-based Stress-Reduction (MBSR) shows promise for depression treatment but lacks feasibility for those with socioeconomic disadvantage or functional disability precluding group attendance. We piloted an iPod-based adaptation of MBSR for cancer patients. We explored patient factors related to intervention use; and associations of usage with depressive symptoms, rest activity rhythms, and cortisol rhythms. Participants reported distress and depressive symptoms. They wore actigraphs and collected waking and bedtime saliva for cortisol assessment over 10 days. A subsequent interview oriented them to mindfulness. They were given iPods with MBSR didactic and meditation practice tracks. Follow-up data were collected at three months. Alpha = 0.10 was adopted for this pilot. The sample (n = 65, 67% female, 78% non–Hispanic white) averaged 23 months post-diagnosis, mostly with advanced or metastatic disease. Thirty-eight participants provided follow-up data, and 24 returned iPods. Usage was not linked with baseline demographic, medical, or psychological factors. Stronger baseline rest-activity and cortisol rhythms emerged as predictors of subsequent intervention use. Usage (total minutes, tracks played) was linked with reduction of depression and bedtime cortisol. It’s interesting that rhythms, not clinical factors/symptoms, predicted iPod use. Future research should continue to explore the potential of simple media-based interventions to alleviate psychological symptoms in patients with advancing cancer.

Depression differed by midnight cortisol secretion, alexithymia and anxiety between diabetes types: a cross sectional comparison

BackgroundIncreased prevalence of depression is found in both type 2 diabetes (T2D) and type 1 diabetes (T1D). Melancholia and atypical depression differ by cortisol secretion and clinical features. The aim was to compare the clinical presentation of T1D and T2D patients in relation to self-reported depression, self-reported anxiety, alexithymia, obesity, and midnight salivary cortisol (MSC).MethodsComparative cross-sectional design. The participants were consecutively recruited from one hospital diabetes outpatient clinic: 24 T2D patients (31–59 years) and 148 T1D patients (32–59 years). Self-reported depression, anxiety and alexithymia were assessed by Hospital Anxiety and Depression scale and Toronto Alexithymia Scale-20. MSC, HbA1c, anthropometrics and data from medical records were collected. Multiple logistic regression analyses were performed.ResultsComparisons of prevalence between diabetes types showed for T2D/T1D: depression 25%/12% (P = 0.10); high MSC (≥9.3 nmol/L) 38%/22% (P = 0.13); alexithymia 25%/13% (P = 0.12); anxiety 38%/35% (P = 0.82). The prevalence of high MSC did not differ between depressed and non-depressed T2D patients (17% vs. 44%, P = 0.35), but differed between depressed and non-depressed T1D patients (53% vs. 18%, P = 0.003). The alexithymia prevalence differed between depressed and non-depressed T2D patients (67% vs.11%, P = 0.018), and between depressed and non-depressed T1D patients (47% vs. 11%, P < 0.001). The anxiety prevalence did not differ between depressed and non-depressed T2D patients (67% vs. 28%, P = 0.15), but differed between depressed and non-depressed T1D patients (76% vs. 30%, P < 0.001). The obesity prevalence (BMI ≥30 kg/m2) was 83% for depressed T2D patients and 6% for depressed T1D patients.In the T2D patients, depression was associated with alexithymia (Adjusted odds ratio (AOR) 15.0). In the T1D patients, depression was associated with anxiety (AOR 11.0), foot complications (AOR 8.5), HbA1C >70 mmol/mol (AOR 6.4), and high MSC (≥9.3 nmol/L) (AOR 4.8).ConclusionsThe depressed T2D patients had traits of atypical depression, without associated high MSC (≥9.3 nmol/L) and anxiety, but the association with alexithymia was strong. The depressed T1D patients had traits of melancholia with associated high MSC and anxiety. The obesity prevalence was high in depressed T2D patients and low in depressed T1D patients.

Etiologic specificity of waking Cortisol: Links with maternal history of depression and anxiety in adolescent girls

BackgroundMany previous studies have indicated that individuals who are depressed or at risk for depression are characterized by increased levels of morning cortisol and a greater cortisol awakening response (CAR). However, despite the high comorbidity between depressive and anxiety disorders, fewer studies have examined whether these diurnal cortisol abnormalities are also characteristic of anxiety or risk for anxiety. MethodsIn the present study we examined cortisol in a community sample of 476 female adolescents and related it to maternal history of depression and/or anxiety disorders. Salivary cortisol was collected at waking, 30min post waking, and in the evening on three weekdays. ResultsContrary to prior results, offspring at risk for depression did not have increased morning cortisol or CAR. However, offspring at risk for anxiety disorders had elevated 30min cortisol and total cortisol produced throughout the day; this effect was primarily driven by offspring of mothers with panic disorder or agoraphobia. Additionally, levels of cortisol were highest among offspring of mothers with multiple anxiety diagnoses. LimitationsThe study is limited to female adolescents and maternal diagnostic history. Additionally, some diagnoses could not be examined as a result of too few cases (e.g. GAD). ConclusionsOverall, these results underscore the importance of considering anxiety when examining the association of diurnal cortisol abnormalities with risk for psychopathology, as it may have influenced prior observations of elevated morning cortisol in depression.

PS196. Alterations of the cortisol and dehydroepiandrosterone in perinatal depression

PS196. Alterations of the cortisol and dehydroepiandrosterone in perinatal depression

Cortisol level in depressed patients and its relation with suicidal risk and anhedonia

Context In recent times, there has been an increased interest in research related to anhedonia. Nevertheless, its linkage to major depressive disorders and underlying neurobiology are still not well understood. High levels of cortisol are associated with an increased risk for suicide as evidenced by several studies; however, others have not found this association between cortisol levels and suicidality. Aim The aim of this work was to examine whether there is an increased activity of the hypothalamic–pituitary–adrenal axis in major depressive disorder patients and to detect the presence of an association between the level of cortisol and thoughts of death and anhedonia in at-risk patients with major depressive disorder. Settings and design This case–control study that was conducted on 20 patients with major depressive disorder, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, in comparison with 20 controls. Patients and methods All patients were assessed using the Present State Examination 10th revision of the Schedules of Clinical Assessment in Neuropsychiatry, Snaith Hamilton Pleasure Scale, Beck’s Suicidal Ideation Scale, and Beck’s Depressive Inventory. Blood samples were collected to assess plasma cortisol level in the morning and evening. Statistical analysis Statistical calculations were carried out using SPSS, version 15. Results There were increased levels of morning and evening cortisol in major depressive disorder patients. Thoughts of death were positively associated with elevated morning cortisol in depression. Anhedonia was associated with higher evening cortisol level in depressed patients in the studied sample. Conclusion There are relatively increased levels of morning and evening cortisol in major depressive disorder patients in comparison with controls; thoughts of death are positively associated with elevated morning and evening cortisol level.

Hypothalamus-pituitary-adrenal-axis associations with self- vs. parental ratings of depression in boys with an autism spectrum disorder

AbstractDepression can be a major comorbidity in young people with an autism spectrum disorder (ASD). Although there is an association between major depressive disorder (MDD) and cortisol concentrations in non-ASD children, relatively little is known about that relationship in children with an ASD, or whether there are development effects on the relationship. It is also unclear whether self-reports or parents’ reports of depression in these children are more closely associated with cortisol.Salivary cortisol from morning and afternoon, plus Child and Adolescent Symptom Inventory responses for MDD, were collected from a sample of 139 boys with an ASD. Parents of these boys also provided ratings of their sons on the Child and Adolescent Symptom Inventory for MDD.Afternoon cortisol was significantly correlated with total depression scores for younger boys but not for older boys. There were also significant differences between the parents’ and the boys’ ratings for five of the 10 MDD symptoms. Parents’ ratings of their sons’ MDD symptoms of irritability, feeling sad or depressed, and sleeping problems were significantly correlated with the boys’ cortisol concentrations. Both boys’ and their parents’ ratings for thoughts of death, feeling worthless, and concentration problems were significantly associated with the boys’ cortisol concentrations.A reliable assessment of MDD in young people with an ASD requires careful consideration of the relative validity of parents’ and children’s reports of the latter’s individual MDD symptomatology.

Depressive symptomatology and cortisol concentrations in elderly community residents: a cross-sectional study.

Researches seek to understand the links between adverse health outcomes and cortisol concentrations. However, the relationship between depressive symptomatology and cortisol concentrations is controversial in the literature. To analyze the relationship between the depressive symptomatology and the cortisol concentrations in elderly community residents in the Brazilian Northeast. Cross-sectional study is composed of 256 elderly (≥65years). Depressive symptomatology was evaluated by the Center for Epidemiologic Studies-Depression Scale and cortisol concentrations by salivary collection (upon waking, 30 and 60min after waking, at 3pm and before bed), in addition to composite measurements. Sociodemographic and health conditions were evaluated. For analysis of the cortisol measurements in relation to depressive symptomatology, and between genders, the Student's t test was used. For cortisol measurements in every curve, analysis of variance for repeated measurements with Bonferroni post hoc test was used. There were significant salivary cortisol differences upon awakening, among elderly with and without depressive symptomatology (p=0.04). There was no significance in relation to gender. Between measurements of each curve, elderly with depressive symptomatology showed no significant difference between the 1st measure in relation to the 2nd and 3rd, and also between the 4th and 5th, demonstrating higher cortisol night levels in elderly with depressive symptomatology, without decline, with curve plane aspect. The relationship between depressive symptomatology and hypocortisolism throughout the day seems to exist. However, in Brazil, adverse life conditions can lead to chronic stress and be sufficient factors to superpose biggest differences that could exist in relation to the presence of depressive symptomatology.

An infant with Cushing syndrome

Case Presentation An 8 month-old boy was referred to the endocrinology clinic for concerns of growth failure since 3 months of age. He was born full term with a birth weight of 2.67kg and a length of 45cm. His parents noticed that he was not growing well from 3 months of age. However, his weight gain remained more than satisfactory and he gained 700g in the past month. This infant was otherwise in good health, apart from atopic dermatitis, for which the parents had been applying a daily cream with good effect. He was breast fed until 2 months of age and weaned onto solids at 6 months of age. On examination, the infant had a moon face with hypertrichosis, facial telangiectasia and prominent supraclavicular fat pads. His recumbent length was 62cm (<3 percentile), his weight was 7.74 kg (25 percentile), and his head circumference was 41.0 cm (3 percentile). There was no hyperpigmentation or lentigenes, but he was hypertensive with a blood pressure of 140/90 mmHg (95 percentile for age is 99/55 mm Hg) with a heart rate of 140 beats/minute. His apex beat was not displaced and his heart sounds were normal with no murmurs. A random steroid profile demonstrated a depressed serum cortisol level of 30 nmol/L and an unmeasurably low serum ACTH level of <1.1 pmol/L. This was consistent with exogenous Cushing syndrome. An ECG showed biventricular hypertrophy and a 2-D echocardiogram confirmed severe biventricular hypertrophy with good ventricular function. On further questioning, he had been receiving twice daily applications of a topical cream for atopic dermatitis, which had been obtained over the counter, without a prescription. Subsequent analysis of the topical agent revealed the contents to be betametasone dipropionate, a high potency corticosteroid. On establishing the diagnosis of exogenous Cushing syndrome, the offending topical steroid cream was discontinued. Since he was at risk of primary adrenal failure from sudden withdrawal of steroid cream, he was started on a weaning regimen of hydrocortisone. He was also commenced on captopril which achieved good blood pressure control.