Diurnal Salivary Cortisol Research Articles

Maternal Early Life Experiences and Parenting: The Mediating Role of Cortisol and Executive Function

Research suggests that early life adversity may affect subsequent parenting. Animal studies investigating mechanisms of transmission have focused on biological factors; whereas research in humans has emphasized cognitive and psychosocial factors. We hypothesized that neuropsychological and physiological factors would act as mediators between maternal retrospective reports of early life experiences (ELE) and current parenting. We recruited a community sample of 89 mothers and their infants (2-6 months of age). Maternal ELE consisted of self-reports of consistency of care and childhood maltreatment. Diurnal salivary cortisol samples were collected as the measure of hypothalamic-pituitary-adrenal (HPA) function. Executive function measures included attentional set-shifting and spatial working memory. Maternal sensitivity was assessed through videotapes of mothers interacting with their infants. A series of path analyses indicated that maternal ELE was indirectly related to maternal sensitivity via two pathways: one through HPA function, and the other through HPA function and spatial working memory. There was no direct path between maternal ELE and parenting. These findings provide support for the notion that mediators linking early life experiences to parenting in humans may be similar to physiological mechanisms found in animal models. As maternal care is associated with numerous infant outcomes, our findings may have broad relevance to understanding the risk associated with parenting and adverse outcomes in infants. A greater understanding of mechanism is important to informing interventions targeted at disrupting maladaptive trajectories of parenting.

Depressive Symptoms and Diurnal Salivary Cortisol Patterns Among Female Caregivers of Stroke Survivors

Informal caregivers of stroke survivors experience elevated chronic stress and are at risk of developing depressive symptoms. The cumulative effects of chronic stress can increase allostatic load and dysregulate biological processes, thus increasing risk of stress-related disease. Stress-induced alterations in the pattern of cortisol secretion vary with respect to stressor onset, intensity, and chronicity. Little is known about the psychoendocrine response to stress in female caregivers of stroke survivors. The purpose of this study was to examine perceived stress, caregiver burden, and the association between caregiver depressive symptoms and diurnal cortisol in 45 females caring for a significant other who experienced a stroke within the past year. Women completed the Center for Epidemiologic Studies Depression Scale (CES-D) and collected saliva for cortisol upon awakening, 30 min postawakening, noon, and bedtime for 2 consecutive days. Results revealed that women had high levels of perceived stress and caregiver burden. In women with CES-D scores ≥ 16, salivary cortisol levels were significantly lower across the day relative to women with CES-D scores < 16. This difference persisted after adjusting for age, number of caregiving hours per week, perceived social support, and quality of sleep. Younger age was associated with more depressive symptoms as well as lower levels of cortisol at awakening and 30 min postawakening. Results demonstrate that the burden of caregiving increases risk of depressive symptoms and hypocortisolism across the day. Hypocortisolism may contribute to increased risk of depressive symptoms as a result of the loss of glucocorticoid attenuation of stress-induced inflammation.

Salivary Cortisol: A Tool for Biobehavioral Research in Children

Measurement of salivary cortisol has been widely used in pediatric research for more than 20 years as a biomarker of hypothalamic pituitary adrenal (HPA) axis activity during normal activity and in response to stress. McCarthy et al. (2010) recently reported cognitive-behavioral interventions that were effective in reducing pain and distress in children undergoing intravenous needle insertion and salivary cortisol measurement was a useful marker of biological response to compare the effect of interventions in conjunction with other physiological and/or behavioral outcome measures. The inclusion of salivary cortisol as an outcome measure would provide a useful biological marker with future research to investigate: stress in children undergoing painful procedures, weight loss, sleep problems, as well as caregiver stress. The use of salivary cortisol in pediatric biobehavioral research has revealed important information about the pattern of cortisol secretion during childhood, the response to stressors in a non-clinical environment, the response to therapeutic interventions, and the identification of dysfunctional patterns of secretion in children. Salivary cortisol is a reliable non-invasive method to assess HPA function, however collection and measurement of specimens with infants and children requires special consideration. This paper will summarize pertinent issues related to salivary cortisol collection to encourage “broader employment” of this method in pediatric biobehavioral research. Various psychological and physical stressors can activate the HPA axis such that corticotrophin releasing hormone (CRH) and adrenocorticotropin hormones (ACTH) are released with subsequent rise in cortisol levels. Once the HPA axis is activated, it takes approximately 15–30 minutes for the cortisol levels to peak. Cortisol secretion has a circadian pattern, peaking in the early morning (approximately 20–30 minutes after awakening) with the nadir around midnight (Stratakis, Gold, & Chrousos, 1995), and short bursts of secretion over the course of the day. The diurnal pattern of cortisol secretion is typically established in early infancy (Price, Close, & Fielding, 1983). HPA axis function and regulation has been shown to have a significant impact on growth and development. Poor regulation of the cortisol response to emotional stress correlates with detrimental effects on cognitive and emotional functioning (Lupien, 2009). Salivary cortisol is a measure of unbound, or “free” cortisol that is biologically relevant with the ease of sampling in clinical and field settings. Saliva sampling is reliable, non-invasive method to measure biologically active, unbound plasma of cortisol in infants and children. Salivary testing offers advantages over venipuncture since it is noninvasive and less likely to confound results. Also, multiple samples can be obtained without increasing ethical concerns. This method is extensively used in psychoneuroendocrinological research (Kirschbaum & Hellhammer, 1994). For example, studies of naturalistic life events that are considered stressful, such as starting school for a child, have incorporated salivary cortisol as an outcome measure to investigate normal versus mal-adaptive responses (Boyce et al., 1995). Also, studies of diurnal salivary cortisol patterns provide insight regarding the role of early environmental factors on cortisol regulation, cognition, and growth (Gutman & Nemeroff, 2003). In addition, salivary cortisol is a useful diagnostic test in the evaluation of suspected cortisol dysregulation (Gafni, Papanicolaou, & Nieman, 2000). For excellent reviews see: Hanrahan, 2006; Jessop & Turner-Cobb, 2006; Kirschbaum & Hellhammer, 1994; and Schmidt, 1997.

Stress management skills, neuroimmune processes and fatigue levels in persons with chronic fatigue syndrome

Stressors and emotional distress responses impact chronic fatigue syndrome (CFS) symptoms, including fatigue. Having better stress management skills might mitigate fatigue by decreasing emotional distress. Because CFS patients comprise a heterogeneous population, we hypothesized that the role of stress management skills in decreasing fatigue may be most pronounced in the subgroup manifesting the greatest neuroimmune dysfunction. In total, 117 individuals with CFS provided blood and saliva samples, and self-report measures of emotional distress, perceived stress management skills (PSMS), and fatigue. Plasma interleukin-1-beta (IL-1β, IL-2, IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α), and diurnal salivary cortisol were analyzed. We examined relations among PSMS, emotional distress, and fatigue in CFS patients who did and did not evidence neuroimmune abnormalities. Having greater PSMS related to less fatigue (p=.019) and emotional distress (p<.001), greater diurnal cortisol slope (p=.023) and lower IL-2 levels (p=.043). PSMS and emotional distress related to fatigue levels most strongly in CFS patients in the top tercile of IL-6, and emotional distress mediated the relationship between PSMS and fatigue most strongly in patients with the greatest circulating levels of IL-6 and a greater inflammatory (IL-6):anti-inflammatory (IL-10) cytokine ratio. CFS patients having greater PSMS show less emotional distress and fatigue, and the influence of stress management skills on distress and fatigue appear greatest among patients who have elevated IL-6 levels. These findings support the need for research examining the impact of stress management interventions in subgroups of CFS patients showing neuroimmune dysfunction.

Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: The role of parental psychosocial risk and monitoring

Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic–pituitary–adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.

Is the Diurnal Profile of Salivary Cortisol Concentration a Useful Marker for Measuring Reported Stress in Acupuncture Research? A Randomized Controlled Pilot Study

This pilot study on the use of traditional Chinese acupuncture (TCA) to treat chronic stress explored the use of the diurnal salivary cortisol profile as a potential outcome measure. Adult volunteers (n=18) with high self-reported stress levels, ascertained by screening with the Perceived Stress Scale 14, were randomized into three groups. Group 1 received weekly sessions of TCA for 5 weeks; Group 2 received attention only weekly (practitioner present and subject supine) for 5 weeks, and group 3 acted as a waiting-list control. A diurnal cortisol profile was constructed for each individual at nine data points: two at baseline, five during the intervention, and two postintervention. A salivary cortisol sample was taken at four time points (on waking, 30 minutes, 3 hours, and 12 hours after waking). Salivary cortisol concentrations were measured using a high-sensitivity salivary cortisol enzyme immunoassay. The cortisol awakening response showed an average increase during the intervention for both TCA and attention groups, indicating that for these two groups the cortisol response had normalized and they were in a lower state of stress. These trends did not reach statistical significance due to individual variation and the small number of study participants. The control group showed an overall decrease in the average morning increase over the same period. No significant difference in the day decline in cortisol was found between groups at any point in the study. This pilot study suggests that TCA could reduce stress and increase the morning rise of the cortisol profile; however, this was not distinguishable from the effect of attention only. Further work with a larger sample is necessary to provide a definitive answer regarding whether this could be sustained with more TCA treatments. The morning cortisol increase could be a useful outcome measure for monitoring the effects of treatment on perceived stress.

Familial Longevity Is Marked by Lower Diurnal Salivary Cortisol Levels: The Leiden Longevity Study

BackgroundReported findings are inconsistent whether hypothalamic-pituitary-adrenal (HPA) signaling becomes hyperactive with increasing age, resulting in increasing levels of cortisol. Our previous research strongly suggests that offspring from long-lived families are biologically younger. In this study we assessed whether these offspring have a lower HPA axis activity, as measured by lower levels of cortisol and higher cortisol feedback sensitivity.MethodsSalivary cortisol levels were measured at four time points within the first hour upon awakening and at two time points in the evening in a cohort comprising 149 offspring and 154 partners from the Leiden Longevity Study. A dexamethasone suppression test was performed as a measure of cortisol feedback sensitivity. Age, gender and body mass index, smoking and disease history (type 2 diabetes and hypertension) were considered as possible confounding factors.ResultsSalivary cortisol secretion was lower in offspring compared to partners in the morning (Area Under the Curve = 15.6 versus 17.1 nmol/L, respectively; p = 0.048) and in the evening (Area Under the Curve = 3.32 versus 3.82 nmol/L, respectively; p = 0.024). Salivary cortisol levels were not different after dexamethasone (0.5 mg) suppression between offspring and partners (4.82 versus 5.26 nmol/L, respectively; p = 0.28).ConclusionOffspring of nonagenarian siblings are marked by a lower HPA axis activity (reflected by lower diurnal salivary cortisol levels), but not by a difference in cortisol feedback sensitivity. Further in-depth studies aimed at characterizing the HPA axis in offspring and partners are needed.

The diurnal salivary cortisol pattern of adolescents from families with single, ill and healthy parents

ObjectiveAdolescents of single and/or chronically ill parents (target groups) reportedly have elevated psychological stress. However, their salivary cortisol pattern as part of the physiological stress system has not been compared to controls. The aim of this study is to examine differential outcomes in the diurnal cortisol pattern of the target groups. MethodsIn total, 100 adolescents of three groups with either single, chronically ill or two healthy parents were compared on cortisol. Three salivary cortisol samples were taken after awakening, one sample at noon and one sample at 20:00p.m. during a non-school day. Group differences and interaction effects between measurement (5 times), group membership and covariates were tested through linear mixed modeling, repeated measures. Covariates were children's sex and age, socioeconomic status (SES) and parental depression as measured with the Beck Depression Inventory. ResultsThe three groups did not differ significantly concerning the amount of salivary cortisol, even after controlling for the covariates. The target groups had a lower SES than adolescents with two healthy parents. In addition, chronically ill parents were more depressed than single and healthy parents. Male sex and older age of the child, and lower parental depression were associated with increased cortisol values throughout the day. ConclusionResearch on cortisol in children should control for children's sex and age, and parental depression. Adolescents with single and/or chronically ill parents displayed a healthy pattern of diurnal salivary cortisol.

A follow-up of cognitive performance and diurnal salivary cortisol changes in former burnout patients

The purpose of this study was to determine whether recovery from burnout is associated with improved cognitive functioning, and whether such improvement is associated with changes in hypothalamic–pituitary–adrenal axis activity and return to work. Forty-five former burnout patients were followed up after 1.5 years with a neuropsychological examination, diurnal salivary cortisol measurements, dexamethasone suppression test (DST), and self-ratings of cognitive problems. At follow-up, improved cognitive performance was observed on several tests of short-term memory and attention. Self-rated cognitive problems decreased considerably, but this decrease was unrelated to the improvement on neuropsychological tests. Diurnal salivary cortisol concentrations at awakening, 30 min after awakening, and in the evening, did not change from baseline to follow-up, nor did the cortisol awakening response. However, slightly, but significantly, stronger suppression of cortisol in response to the DST was observed at follow-up. Improvements in subjective or objective cognitive functioning and changes in diurnal cortisol concentration were unrelated to the extent of work resumption. However, a decreased DST response at follow-up was partially related to improved cognitive performance and work resumption. The clinical implications are that burnout seems to be associated with slight and significantly reversible cognitive impairment, and that self-rated cognitive change during recovery poorly reflects objective cognitive change.

Diurnal Cortisol and Functional Outcomes in Post-Acute Rehabilitation Patients

Cortisol is a stress-related hormone with a robust circadian rhythm where levels typically peak in the morning hours and decline across the day. Although acute cortisol increases resulting from stressors are adaptive, chronic elevated cortisol levels are associated with poor functioning. Studies have shown age-related changes in cortisol levels. The present study investigated the relationship between salivary diurnal cortisol and functional outcomes among older adults undergoing inpatient post-acute rehabilitation. Thirty-two older adults (mean age 78 years; 84% men) in a Veterans Administration inpatient post-acute rehabilitation unit were studied. Functional outcomes were assessed with the motor component of the Functional Independence Measure (mFIM; where mFIM change = discharge - admission score). Saliva samples were collected on 1 day at wake time, 45 minutes later, 11:30 AM, 2 PM, 4:30 PM, and bedtime. We analyzed the relationship between cortisol measures and functional outcomes, demographics, and health measures. The analyses consistently showed that greater functional improvement (mFIM change) from admission to discharge was associated with lower comorbidity scores and higher cortisol levels at 2 PM, 4:30 PM, and bedtime. A morning cortisol rise was also associated with greater mFIM change. Measurement of cortisol in saliva may be a useful biological marker for identification of patients who are "at risk" of lower benefits from inpatient rehabilitation services and who may require additional assistance or intervention during their post-acute care stay.

Changes in Diurnal Salivary Cortisol Secretion following Cognitive-Behavioral Therapy in Patients with Panic Disorder

Changes in Diurnal Salivary Cortisol Secretion following Cognitive-Behavioral Therapy in Patients with Panic Disorder

Diurnal salivary cortisol and urinary catecholamines are associated with diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis

The objective was to examine the cross-sectional association of diurnal salivary cortisol curve components and urinary catecholamines with diabetes status. Up to 18 salivary cortisol samples over 3 days and overnight urinary catecholamines were collected from 1002 participants in the Multi-Ethnic Study of Atherosclerosis. Diabetes was defined as a fasting blood glucose of at least 126 mg/dL or medication use. Cortisol curve measures included awakening cortisol, cortisol awakening response, early decline, late decline, and cortisol area under the curve (AUC). Urinary catecholamines included epinephrine, norepinephrine, and dopamine. Participants with diabetes had significantly lower cortisol awakening response (β = −0.19; 95% confidence interval [CI], −0.34 to −0.04) than those without diabetes in multivariable models. Whereas men with diabetes had a nonsignificant trend toward lower total AUC (β = −1.56; 95% CI, −3.93 to 0.80), women with diabetes had significantly higher total AUC (β = 2.62; 95% CI, 0.72 to 4.51) (P = .02 for interaction) compared with those without diabetes. Men but not women with diabetes had significantly lower urinary catecholamines compared with those without diabetes (P < .05). Diabetes is associated with neuroendocrine dysregulation, which may differ by sex. Further studies are needed to determine the role of the neuroendocrine system in the pathophysiology of diabetes.

Fish consumption, low-level mercury, lipids, and inflammatory markers in children

There is considerable evidence that consuming fish has numerous health benefits, including a reduced risk of cardiovascular disease. However, fish is also the primary source of human exposure to mercury (Hg). In a cross-sectional study of 9–11 year old children (N=100), we measured fish consumption, blood lipids, total blood Hg, diurnal salivary cortisol (4 samples collected throughout the day), and performed a proteomic analysis of serum proteins using spectral count shotgun proteomics. Children who consumed fish had a significantly more atheroprotective lipid profile but higher levels of blood Hg relative to children that did not consume fish. Although the levels of blood Hg were very low in these children (M=0.77μg/L; all but 1 participant had levels below 3.27μg/L), increasing blood Hg was significantly associated with blunted diurnal cortisol levels. Blood Hg was also significantly associated with acute-phase proteins suggesting systemic inflammation, and several of these proteins were found to significantly reduce the association between Hg and diminished cortisol when included in the model. This study of a pediatric population is the first to document an association between blood Hg, systemic inflammation, and endocrine disruption in humans. Without a better understanding of the long-term consequences of an atheroprotective lipid profile relative to blunted diurnal cortisol and systemic inflammation, a determination of the risk-benefit ratio for fish consumption by children is not possible.

Cortisol Diurnal Rhythm and Stress Reactivity in Constipation and Abdominal Pain

The aim of this study was to assess whether diurnal cortisol rhythm and cortisol stress reactivity were associated with functional constipation and abdominal pain in infancy. This study was embedded in a subset of the Generation R Study, a prospective cohort study from fetal life onward in Rotterdam, the Netherlands. Data of infants between 14 and 24 months of age (N =483) were used. Salivary cortisol diurnal rhythm and salivary cortisol stress reactivity after a Strange Situation Procedure were assessed at age 14 months. Data on functional constipation were available according to the Rome II criteria, and data on abdominal pain on the basis of the Abdominal Pain Index were available from questionnaire data at 24 months. In the second year of life, 13% of the infants had functional constipation and 17% had abdominal pain. Only 4% had symptoms of both functional constipation and abdominal pain. Diurnal cortisol rhythm did not differ significantly between children with and children without functional constipation and abdominal pain. Cortisol stress reactivity was slightly higher in infants with abdominal pain than in those without it, but this was not statistically significant (odds ratio 1.41; 95% confidence interval 0.46-4.31). No association was found between the cortisol stress reactivity and functional constipation. Our results suggest that cortisol as a marker for stress does not play a major role in functional constipation or abdominal pain in infancy.

Associations of Trait Optimism With Diurnal Neuroendocrine Activity, Cortisol Responses to Mental Stress, and Subjective Stress Measures in Healthy Men and Women

To examine the associations of dispositional optimism with diurnal salivary cortisol, cortisol responses to standardized laboratory stress, and task-induced subjective stress and control in a sample of individuals 53 years and older. Five hundred forty-three healthy men and women (mean [standard deviation] age, 62.9 [5.7] years) attended a psychophysiological stress session and provided five salivary cortisol samples during a normal day. During the stress testing session, cortisol responses to two behavioral tasks were assessed. The associations of dispositional optimism with cortisol and subjective appraisal were assessed using hierarchical multiple regression analysis. The cortisol awakening response, but not the diurnal profile, was negatively associated with optimism independently of age, sex, employment grade, body mass index, smoking status, depressive symptoms, and time of awakening (β = -0.12, p ≤ .05). No associations were observed between optimism and stress-induced cortisol changes in the laboratory; however, perceived stress was lower (β = -0.18, p ≤ .001), and perception of control was higher (β = 0.18, p ≤ .001), in more optimistic participants during the psychophysiological testing session. Dispositional optimism may confer benefits to the individual through attenuated hypothalamic-pituitary-adrenal axis response to waking in everyday life. However, no evidence emerged for an association between optimism and cortisol laboratory stress responses, which suggests that other compensatory mechanisms might play a role.

Salivary cortisol in pregnant women suffering from blood and injection phobia

Stress and/or anxiety during pregnancy affect maternal and fetal well-being and can cause premature delivery and postnatal pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress, including anxiety and sometimes panic attacks, during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions of maternal psychological factors may be transduced to the fetus. The aim of this study was to investigate whether pregnant women suffering from blood and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary cortisol profiles compared with healthy controls. The sample consisted of 110 pregnant women with blood and injection phobia and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in weeks25 and 36 for the assay of cortisol. In gestational week25, when blood was drawn for the mandatory blood testing, extra blood was taken to analyze corticotrophin-releasing factor, adrenocorticotropic hormone, and cortisol in serum. The diurnal decline in salivary cortisol as well as increased cortisol levels were observed during pregnancy. Pregnant women suffering from blood and injection phobia had a higher output of cortisol compared with women without the phobia (F = 6.25, df = 1, p = 0.014), but no marked difference in the diurnal cortisol rhythm was found between groups. Our findings indicate that untreated blood and injection phobia during pregnancy increases cortisol concentrations. Blood and injection phobia is treatable, and cognitive behavioral therapy can be used. Women with blood and injection phobia during pregnancy therefore need to be recognized and offered treatment without delay in early pregnancy.

A Clinical Translation of the Research Article Titled “Changes in Diurnal Salivary Cortisol Levels in Response to an Acute Stressor in Healthy Young Adults”

A Clinical Translation of the Research Article Titled “Changes in Diurnal Salivary Cortisol Levels in Response to an Acute Stressor in Healthy Young Adults”

Changes in Diurnal Salivary Cortisol Levels in Response to an Acute Stressor in Healthy Young Adults

Knowledge of the diurnal cortisol response to acute stress in healthy individuals can help us better understand the physiological and health effects of chronic stress. To compare the diurnal patterns of cortisol secretion of 15 medical students 2 weeks before a major written examination (control phase) and 2 weeks later at the time of the examination (acute stress phase). Interrupted time series within-subjects. During the acute stress phase, less cortisol was secreted over the course of the day, as demonstrated by a more prolonged and steeper decline in cortisol levels. In addition, higher cortisol levels were present in the evening. Despite these changes in the usual diurnal pattern, overall exposure to cortisol remained the same for both phases. The results of this study suggest that specific adaptations to the diurnal pattern of cortisol are made in the face of acute stress, important information for understanding cortisol regulation in health and illness.

Blunted diurnal decline of cortisol among older adults with low socioeconomic status

Low socioeconomic status (SES) is associated with increased risk for adverse health outcomes; those with low SES are thought to experience greater environmental disadvantage and exposure to chronic stress over the life course. The effects of chronic stress on health have been measured by cortisol levels and variations in their diurnal pattern. However, the patterns of association between SES and cortisol have been equivocal in older adults. This paper examined in 98 older adults participating in the Brain Health Substudy of the Baltimore Experience Corps Trial baseline patterns of diurnal variation in salivary cortisol associated with lower versus higher SES using total income and perceived SES relative to others. For each measure, participants stratified into lower versus higher SES showed a more blunted rate of decline in diurnal salivary cortisol over the day in adjusted models (P values ≤ 0.05). There were no SES-related differences in awakening cortisol, cortisol-awakening response, or area under the curve. These findings confirm prior evidence of a biologic pathway through which socioeconomic disadvantage is linked to biologic vulnerability, and through which the impact of volunteer service in Experience Corps may be measured.

Diurnal salivary cortisol concentrations in Parkinson&amp;rsquo;s disease: increased total secretion and morning cortisol concentrations

Background:Parkinson’s disease (PD) is a chronic neurodegenerative disorder. There is limited knowledge about the function of the hypothalamic-pituitary-adrenal axis in PD. The primary aim of this prospective study was to analyze diurnal salivary cortisol concentrations in patients with PD and correlate these with age, gender, body mass index (BMI), duration of PD, and pain. The secondary aim was to compare the results with a healthy reference group.Methods:Fifty-nine PD patients, 35 women and 24 men, aged 50–79 years, were recruited. The reference group comprised healthy individuals matched for age, gender, BMI, and time point for sampling. Salivary cortisol was collected at 8 am, 1 pm, and 8 pm, and 8 am the next day using cotton-based Salivette® tubes and analyzed using Spectria® Cortisol I125. A visual analog scale was used for estimation of pain.Results:The median cortisol concentration was 16.0 (5.8–30.2) nmol/L at 8 am, 5.8 (3.0–16.4) at 1 pm, 2.8 (1.6–8.0) at 8 pm, and 14.0 (7.5–28.7) at 8 am the next day. Total secretion and rate of cortisol secretion during the day (8 am–8 pm) and the concentration of cortisol on the next morning were lower (12.5 nmol/L) in the reference group. No significant correlations with age, gender, BMI, duration of PD, Hoehn and Yahr score, Unified Parkinson’s Disease Rating Scale III score, gait, pain, or cortisol concentrations were found.Conclusion:The neurodegenerative changes in PD does not seem to interfere with the hypothalamic-pituitary-adrenal axis. Salivary cortisol concentrations in PD patients were increased in the morning compared with the reference group, and were not influenced by motor dysfunction, duration of disease, or coexistence of chronic or acute pain.