Evening Cortisol Levels Research Articles

Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis

BackgroundNurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children’s and caregivers’ cortisol levels, and meta-analyzed the results.MethodsIn January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies – randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children’s morning and evening cortisol levels, as well as change across the day.ResultsA total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: − 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: − 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found.ConclusionExisting evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.

SAT-256 The Ever Confusing Cushing’s Work Up: Is It Real? Is It Pseudo Cushing’s’? Or Could It Be Factitious

Case Presentation:A 50 year old female initially presented with progressive weight gain and mood swings. She had normal 24 h urine cortisol, but an elevated midnight serum cortisol. She underwent transphenoidal surgery for a presumed ACTH-dependent Cushing’s disease. Pathology was not supportive of a pituitary adenoma, showing adenohypophyseal tissue with focal expansion of the acini. The surgery was complicated by hypothyroidism and growth hormone deficiency. She was able to weaned off of the steroids after a few months. She had recurrence of her initial symptoms, she was found to have elevated late evening and morning cortisol levels. She underwent a bilateral adrenelactomy for “recurrence of the cyclical Cushing’s symptoms.” She was started on HC replacement; 10 mg AM and 2.5 mg PM, florinef 0.05 mg daily. She slowly lowered the hydrocortisone dose, and as a result lost 120 lbs.Three years later she presented with fatigued and gaining weight, by that time she was on Hydrocortisone 3.75 mg AM, 1.25 mg evening, and fludrocortisone 0.1 mg/day. ACTH was 355 (6–48 pg/ml), serum cortisol 10 (8–19 ug/dl) on Hydrocortisone and < 1.0 ug/dl off cortisone. The 24 h urine free cortisol < 1.0 (10–24 ug/34h), and 17 OH- corticosteroids < 4.8(4–14 mg/dl). A possible adrenal remnant was seen on abdominal CT, surgically removed of the lesion showed a lipoma.She was referred to Neurosurgery for a second pituitary surgery for the concern Cushing’s recurrence. A pituitary MRI revealed a small potential microadenoma. The small dose of hydrocortisone was held for 48 h and an 8 AM test dose: Serum cortisol < 1.20 mcg/dl (3–18), ACTH 1,077 pg/ml (5–72), 24 h urine cortisol < 1.5 mcg/24h (3.5–45), 24 h urine cortisone 10 mcg/24h (17–129), and two midnight salivary cortisol were 128 and 265 ng/dl (< 100 ng/dl). There was a concern raised by the laboratory for a contaminated salivary sample, as the salivary cortisol to cortisone ratio was concerning for contamination with exogenous steroid (1)Discussion:Work up for Cushing’s syndrome can be very confusing and frustrating at times for the patient and their physicians. Doing a meticulous work up is necessary to reach an accurate conclusion. Misdiagnosing Cushing’s can lead to a cascade of mistreatment with serious consequences. The case presented highlights the challenges encountered in taking care of such patients. It is necessary to understand the pre-testing probability to reach a precise conclusion. Factitious disorder or sample contamination can be yet another challenge in the differential diagnosis of Cushing’s work up.(1)Raff H Measurement of Late-Night, Salivary Cortisol and Cortisone by LC-MS/MS to Assess Preanalytical Sample Contamination with Topical Hydrocortisone. Clinical Chemistry 58:5 (2012)

Maternal emotion dysregulation and physiological concordance in mother‐preschooler dyads

AbstractMaternal emotional and physiological dysregulation has been found to influence child stress physiology. This study characterizes diurnal cortisol and basal heart rate variability (HRV) patterns in a predominately high‐risk sample of mothers with a full range of emotion dysregulation and assessed the magnitude of concordance (N = 68 mother‐preschooler dyads). Overall, dyads exhibited concordance in evening salivary cortisol levels, but not for morning levels or HRV. Maternal emotion dysregulation was associated with maternal and child evening cortisol levels, child morning cortisol levels, and maternal HRV. Bootstrapping analyses showed that maternal emotion dysregulation was associated with higher child evening cortisol levels through its impact on mother evening cortisol levels. This study offers preliminary evidence for understanding child stress physiology and dyadic concordance in a sample of mothers with a range of emotion regulation capabilities.Highlights Maternal physiology may explain the association between maternal emotion dysregulation and child physiological patterns. Emotionally dysregulated mothers were oversampled and mothers and children's heart rate variability and cortisol were collected, with findings showing dyadic concordance in evening cortisol. This work highlights the importance of transdiagnostic approaches for examining concordance and child stress physiology.

The relationship between sleep problems and cortisol in people with type 2 diabetes

BackgroundSleep problems are linked with negative health outcomes, including coronary heart disease. Neuroendocrine dysfunction has been associated with sleep problems and may be a pathway linking sleep and ill health. Dysregulated cortisol output has observed in people with type 2 diabetes (T2D), though little is known about the links between sleep and cortisol in this population at high risk of coronary disease. MethodThis study investigated the association between sleep problems and cortisol over the course of an ordinary day and in response to acute laboratory stress in a sample of 129 individuals with T2D. Sleep problems were assessed using the Jenkins sleep problems questionnaire. Mental stress was induced using two five-minute laboratory stress tasks: a mirror-tracing task and the Stroop color-word interference task. ResultsSleep problems were positively associated with daily cortisol area under the curve (B = 17.051, C.I. = 6.547 to 27.554, p = 0.002) adjusting for age, sex, marital status, education, household income, body mass index and smoking; suggesting that those with greater sleep problems had greater cortisol concentrations over the course of an ordinary day. Participants reporting greater sleep problems also had raised evening cortisol levels (B = 0.96, C.I. = 0.176 to 1.746, p = 0.017) in adjusted models. In the laboratory sleep problems were negatively associated with cortisol immediately post-task (B = -0.030, C.I. = -0.059 to 0.000, p = 0.048) and 45 minutes post-task (B = -0.037, C.I. = -0.072 to -0.002, p = 0.039) in fully adjusted models; indicating that those who experienced greater sleep problems had lower cortisol concentrations after stress. ConclusionsSleep problems were associated with disturbances in cortisol responses to stress, as well as changes diurnal cortisol output in people with T2D. Further research is needed to assess if neuroendocrine disturbance increases the risk of cardiovascular disease in this population.

Latino early adolescents' psychological and physiological responses during the 2016 U.S. presidential election.

Research has documented increased psychological distress among adults during the 2016 U.S. presidential election; however, little is known about how major political events affect adolescents. Despite not actively participating in the election process (e.g., voting), adolescents generally, and Latino youth specifically, may experience a unique stress response during elections, particularly when perceived policy changes center on issues related to their own families' stability and well-being. We examined 42 Latino early adolescents (Mage = 12.50 years, SD = .88; 58% male; 94% immigrant background) living in Arizona and explored their psychological and physiological responses during the 2016 U.S. presidential election. Adolescents self-reported their mood and behaviors for 5 consecutive days across election week (November 6-10, 2016): 2 days before the election, election day, and 2 days after the election. They also completed a saliva sampling protocol at waking and bedtime each day, to capture diurnal cortisol concentrations. Multilevel growth models were utilized to examine intraindividual changes in positive affect, negative affect, and diurnal cortisol patterns across election week. Only 2 of the participants reported supporting the winning candidate. Changes in adolescents' stress hormone concentrations were evident; increases in evening cortisol levels and flatter diurnal cortisol slopes emerged across election week. Negative affect, positive affect, and morning cortisol concentrations did not change. This study provides preliminary evidence that macrolevel factors, such as the recent presidential election, may relate to adolescents' daily stress physiology. Further research is needed to better understand adolescents' responses to sociopolitical change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The hypothalamic-pituitary-adrenal axis in the perinatal period: Its relationship with major depressive disorder and early life adversity

Objectives: Effects of major depressive disorder and early life adversity (ELA) on the maternal HPA axis in the perinatal period were examined.Methods: Four groups of women (n = 127) were recruited, with the perinatal groups being compared during pregnancy (Preg) and at two months postpartum (PP) – [1] Depressed during pregnancy (Depressed-Preg/PP), [2] Prior history of depression but euthymic during pregnancy (History-Preg/PP), [3] Healthy pregnant women (Control-Preg/PP), and [4] Healthy non-pregnant women (Non-pregnant Control). Serial saliva samples were collected over the course of a day and waking and evening cortisol, total cortisol output and the cortisol awakening response were examined.Results: There were no HPA axis differences among the three groups during pregnancy. A history of ELA, regardless of comorbid depression, was associated with higher evening cortisol levels during pregnancy (p = 0.015). Women in the Depressed-PP group had had higher evening cortisol levels compared to the History-PP group (p < 0.017).Conclusions: Evening cortisol measures are a potential marker for both ELA and depression, with higher levels during pregnancy being associated with ELA and higher levels postpartum being associated with antenatal depression.

Evening salivary cortisol as a single stress marker in women with metastatic breast cancer

BackgroundFlattened diurnal salivary cortisol patterns predict shorter subsequent survival with breast, lung, and renal cell carcinomas. The underlying cause of this flattened slope is undetermined, though it has been hypothesized to be secondary to a deficit in the amplitude of the circadian clock. To gain greater insight into the portions of the diurnal salivary curve that are associated with cancer survival, we examined (1) which points in the diurnal curve are predictive of the slope of the curve and (2) whether elevated evening cortisol levels alone are associated with reduced HPA-axis feedback inhibition (i.e., decreased sensitivity to the dexamethasone suppression test). MethodWe examined study hypotheses on adult women with advanced breast cancer (age = 54.3 ± 9.58 years; n = 99) using non-parametric Wilcoxon’s rank-sum tests, Spearman correlation coefficients and an accuracy formula based on a confusion matrix. Cortisol was sampled five times per day for three consecutive days, with dexamethasone administered late on the second day. ResultsSalivary cortisol concentrations did not vary between those with flat and steep slopes during the morning (p’s > .05), but did vary in the evening (p’s < 0.05). Furthermore, the concentration of the 2100h alone was 86% accurate in discriminating between individuals classified as having “flat” or “steep” slopes. Dexamethasone suppression was only associated with diurnal salivary cortisol slope (p = .0042). ConclusionsEvening cortisol levels are a sensitive indicator flattened diurnal cortisol slope, suggesting evening cortisol may also be a useful predictor of breast cancer survival. Future research should focus on determining the causes of abnormally increased evening cortisol.

Transportation noise impairs cardiovascular function without altering sleep: The importance of autonomic arousals

AimsChronic exposure to nocturnal transportation noise has been linked to cardiovascular disorders with sleep impairment as the main mediator. Here we examined whether nocturnal transportation noise affects the main stress pathways, and whether it relates to changes in the macro and micro structure of sleep. Methods and resultsTwenty-six young healthy participants (12 women, 24.6 ± 0.7 years, mean ± SE) spent five consecutive 24-h days and one last morning in the laboratory. The first (baseline) and last (recovery) nights comprised a quiet ambient scenario. In-between, four different noise scenarios (low/medium/high intermittent road or rail scenarios with an identical equivalent continuous sound level of 45 dB) were randomly presented during the 8-h nights. Participants felt more annoyed from the transportation noise scenarios compared to the quiet ambient scenario played back during the baseline and recovery nights (F5,117 = 10.2, p < 0.001). Nocturnal transportation noise did not significantly impact polysomnographically assessed sleep macrostructure, blood pressure, nocturnal catecholamine levels and morning cytokine levels. Evening cortisol levels increased after sleeping with highly intermittent road noise compared to baseline (p = 0.002, noise effect: F4,83 = 4.0, p = 0.005), a result related to increased cumulative duration of autonomic arousals during the noise nights (F5,106 = 3.4, p < 0.001; correlation: rpearson = 0.64, p = 0.006). ConclusionUnder controlled laboratory conditions, highly intermittent nocturnal road noise exposure at 45 dB increased the cumulative duration of autonomic arousals during sleep and next-day evening cortisol levels. Our results indicate that, without impairing sleep macrostructure, nocturnal transportation noise of 45 dB is a physiological stressor that affects the hypothalamic-pituitary-adrenal axis during the following day in healthy young good sleepers.

Association of Salivary Cortisol Level and Social Media Networking Usage

The present study investigates the usage of social media networking behavior among the MAHSA university students by using structured questionnaire. The salivary cortisol levels among the study groups were estimated. In addition, the association between salivary cortisol and the usage of social media networking was also assessed. Saliva samples were obtained twice a day from selected subjects to analyze the cortisol level. Results of the present study indicate that the 11% of the students spend less than one hour on social media, 40.2% uses two to four hours and 46.4% more than four hours daily; whereas, 2% of the study groups are others. The cortisol levels assessed among the male and female study groups showed high cortisol concentration in both morning and evening. The cortisol levels in the morning seen among the male study group ranges from 0.13-5.49 µg/dl and the female cortisol level ranges from 1.11-5.72 µg/dl. Besides in the evening, the cortisol levels seem to be higher among the study group. The evening cortisol level of male students ranges from 0.06-4.6 µg/dl. Whereas in the females, cortisol level ranges 0.263.9 µg/dl. The average value of the cortisol concentration in the morning is seen to be higher among the female study group than the male and in the evening the male cortisol concentration is seen to be higher than the females. Results clearly demonstrated that students spending more hours in social media had higher cortisol levels when compared to less hour users. From the present preliminary study, it is clear that there is an association between salivary cortisol level and the usage of social media networking behavior.

Saliva cortisol in relation to aircraft noise exposure: pooled-analysis results from seven European countries

BackgroundMany studies have demonstrated adverse effects of exposure to aircraft noise on health. Possible biological pathways for these effects include hormonal disturbances. Few studies deal with aircraft noise effects on saliva cortisol in adults, and results are inconsistent.ObjectiveWe aimed to assess the effects of aircraft noise exposure on saliva cortisol levels and its variation in people living near airports.MethodsThis study focused on the 1300 residents included in the HYENA and DEBATS cross-sectional studies, with complete information on cortisol sampling. All the participants followed a similar procedure aiming to collect both a morning and an evening saliva cortisol samples. Socioeconomic and lifestyle information were obtained during a face-to-face interview. Outdoor aircraft noise exposure was estimated for each participant’s home address. Associations between aircraft noise exposure and cortisol outcomes were investigated a priori for male and female separately, using linear regression models adjusted for relevant confounders. Different approaches were used to characterize cortisol levels, such as morning and evening cortisol concentrations and the absolute and relative variations between morning and evening levels.ResultsStatistically significant increases of evening cortisol levels were shown in women with a 10-dB(A) increase in aircraft noise exposure in terms of LAeq, 16h (exp(β) = 1.08; CI95% = 1.00–1.16), Lden (exp(β) = 1.09; CI95% = 1.01–1.18), Lnight (exp(β) = 1.11; CI95% = 1.02–1.20). A statistically significant association was also found in women between a 10-dB(A) increase in terms of Lnight and the absolute variation per hour (exp(β) = 0.90; CI95% = 0.80–1.00). Statistically significant decreases in relative variation per hour were also evidenced in women, with stronger effects with the Lnight (exp(β) = 0.89; CI95% = 0.83–0.96) than with other noise indicators. The morning cortisol levels were unchanged whatever noise exposure indicator considered. There was no statistically significant association between aircraft noise exposure and cortisol outcomes in men.ConclusionsThe results of the present study show statistically significant associations between aircraft noise exposure and evening cortisol levels and related flattening in the (absolute and relative) variations per hour in women. Further biological research is needed to deepen knowledge of the pathway between noise exposure and disturbed hormonal regulation, and specially the difference in effects between genders.

Green space, air pollution, traffic noise and saliva cortisol in children aged 12 years

OPS 43: Noise, stress and mental health, Room 217, Floor 2, August 27, 2019, 4:30 PM - 5:30 PM Background: Green space, air pollution and traffic noise may be associated with stress levels in children. Secretion of the stress hormone cortisol is characterized by a peak in the early morning, followed by declining cortisol levels throughout the day. A slower rate of decline in cortisol across the day has been related to chronic psychosocial stress. Aim: To examine the associations of green space, air pollution and traffic noise with the diurnal change in saliva cortisol levels in children aged 12 years. Methods: We used data of 1061 participants aged 12 years of the Dutch PIAMA birth cohort. Children collected saliva samples during a single day: 30 minutes after awakening and at 20.00hr (in the evening). We calculated the change between evening and morning saliva cortisol levels (in ng/ml per hour). We estimated residential exposure to green space (i.e. the average Normalized Difference Vegetation Index (NDVI) and percentages of green space in circular buffers of 300m and 3000m), air pollution and traffic noise. Associations of these exposures with the diurnal cortisol change were assessed by multiple linear regression, adjusted for potential confounders. Associations are presented for an interquartile range (IQR) increase in exposure. Results: The average NDVI, total percentage of green space and percentage of agricultural green space in a buffer of 3000m were associated with a stronger diurnal decrease in cortisol levels (adjusted difference -0.05ng/ml/hr [95%CI -0.08, -0.01ng/ml/hr] per IQR (0.13) increase in the average NDVI; adjusted difference -0.05ng/ml/hr [95%CI -0.09, -0.01ng/ml/hr] per IQR (31.1%) increase in the total percentage of green space). We found no associations of air pollution or traffic noise with the diurnal cortisol change. Conclusions: This study indicates that residential exposure to green space may be associated with lower stress levels in children aged 12 years.

HPA axis in psychotic major depression and schizophrenia spectrum disorders: Cortisol, clinical symptomatology, and cognition

The Hypothalamic Pituitary Adrenal (HPA) axis has been implicated in the pathophysiology of a variety of mood and cognitive disorders. Neuroendocrine studies have demonstrated HPA axis overactivity in major depression, a relationship of HPA axis activity to cognitive performance, and a potential role of HPA axis genetic variation in cognition. In schizophrenia differential HPA activity has been found, including higher rates of non-suppression to dexamethasone challenge and higher salivary cortisol levels, which have been a premonitory risk factor for conversion to psychosis in adolescents at risk for developing schizophrenia. The present study investigated the simultaneous roles HPA axis activity and clinical symptomatology play in poor cognitive performance. Patients with major depression with psychosis (PMD) or schizophrenia spectrum disorder (SCZ) and healthy controls (HC) were studied. All participants underwent a diagnostic interview and psychiatric ratings, a comprehensive neuropsychological battery, and overnight hourly blood sampling for cortisol. Cognitive performance did not differ between the clinical groups, though they both performed more poorly than the HC's across a variety of cognitive domains. Across all subjects, cognitive performance was negatively correlated with higher cortisol, and PMD patients had higher evening cortisol levels than did SCZ and HCs. Cortisol and clinical symptoms, as well as age, sex, and antipsychotic use predicted cognitive performance. Diathesis stress models and their links to symptomatology, cognition, and HPA function are discussed.

The relationship between salivary cortisol and perinatal depression in women undergoing termination of pregnancy for fetal anomaly: A prospective cohort study

BackgroundThe hypothalamic-pituitary-adrenal axis plays a crucial role in the neurobiological pathways for depression. The aim of this study was to determine the relationship between salivary cortisol and depression in women before and after termination of pregnancy due to fetal anomaly. Study designA prospective cohort study was conducted. One-way ANOVA and linear correlation were conducted to analyse the relationship between salivary cortisol and depression before and after termination of pregnancy. ResultsNo significant difference in morning and evening cortisol levels between women underwent TOP for fetal anomaly without depression and those with depression, but the women underwent TOP for fetal anomaly had significantly higher levels of morning and evening cortisol than women with healthy pregnancy. Cortisol awakening response was lower in women underwent termination of pregnancy, than in women with normal pregnancy; lower in women underwent termination of pregnancy with depression than in those women without depression. Cortisol awakening response also had a negative correlation with depression, and the correlation coefficients for cortisol awakening response and depression after TOP (R = 0.461) were higher than the correlation coefficients for cortisol awakening response and depression before TOP(R = 0.238). ConclusionsOur results were not only useful to support the hypothesis that hypothalamic-pituitary-adrenal axis functioning would turn hypoactive, with depression progressing to increase in severity, but also helpful with insights into the predictive effects of cortisol awakening response in depression after TOP. We suggest that further research should be conducted on the relationship between salivary cortisol and depression before and after TOP for fetal anomaly.

Depressive symptoms in caregivers immediately after stroke

ABSTRACTBackground: Caregivers of stroke survivors often suffer depressive symptoms that interfere with their own health. Early recognition may lead to attenuation of symptoms and better health and well-being for caregivers.Objective: We examined characteristics of caregivers and stroke survivors associated with caregivers’ depressive symptoms in the early poststroke period.Methods: We conducted a prospective, longitudinal exploratory observational study with a convenience sample of 63 caregivers of older adult (≥ 65 years) stroke survivors recruited from urban acute-care settings. We enrolled caregivers by 2 weeks poststroke (T1) and revisited them 4 weeks later (T2). Depressive symptoms were measured using the Patient Health Questionnaire-9. A separate unadjusted linear mixed model was computed to explore significant associations between each caregiver or stroke-survivor characteristic and depressive symptoms.Results: Caregivers, on average, reported mild depressive symptoms at T1 and T2. Each of the following characteristics was independently associated with caregiver depressive symptoms over the first 6 weeks poststroke: caregiver uncertainty (p < 0.001), perceived stress (p < 0.001) but not cortisol levels (p = 0.858 on waking, p = 0.231 evening), coping (p < 0.001), social support (p = 0.006), race (p = 0.022), income (p = 0.001), time spent on care (p = 0.039), and stroke-survivor race (p = 0.033) and functional status (p = 0.003). At T2, caregiver depressive symptoms were correlated with evening cortisol level (p = 0.001).Conclusions: Caregiver and stroke-survivor characteristics may help identify caregivers at highest risk for early depressive symptoms and guide interventions aimed at their resolution.

Hormonal assessment of participants in a long distance walk

BackgroundExercise can disrupt homeostasis and trigger many adaptive responses in different hormonal axes. The study of hormonal interactions with physical activity is highly complex due to the number of variables, such as exercise duration, exercise intensity, individual level of training, circadian rhythm, nutritional status, and environmental conditions.MethodsThis study was performed to assess daily variations of thyroid hormones, cortisol, testosterone, insulin and glucose during moderate to high intensity aerobic physical activity for 5 consecutive days. Sample collection was performed at baseline in the morning and in the evening, immediately after finishing the activity, on the 4 initial days of the activity. Statistical analysis was performed using software STATA V14. Continuous variables are presented as means and standard deviations, while categorical variables are presented as absolute and percentage values. We used Shapiro–Wilk, Wilcoxon Sign, Mann–Whitney and Student’s T test, according the needs.ResultsThe adrenocorticotropic axis showed an initial increase in the evening cortisol level compared to the baseline level in the morning (17.46 μg/dL and 15.97 μg/dL, respectively) and then exhibited a significant reduction between the 1st and 4th day of activity (17.46 μg/dL and 8.39 μg/dL, respectively; P = 0.001). The same pattern was observed for free thyroxine (T4) between the 1st and 4th day (1.31 and 1.14, respectively; P < 0.001).ConclusionsModerate to intense long duration physical activity resulted in little variation in the hormones assessed, with a trend toward reduced levels of cortisol and free T4. These findings highlight an adaptive hormonal mechanism in response to stress that is repeated daily, as shown by cortisol and thyroid function in our study.

Stress-related genetic polymorphisms in association with peripartum depression symptoms and stress hormones: A longitudinal population-based study

Individual differences in the response of the stress system to hormonal changes during pregnancy and the postpartum period render some women susceptible to developing depression. The present study sought to investigate peripartum depression and stress hormones in relation to stress-related genotypes. The Edinburgh Postnatal Depression Scale was used to assess peripartum depressive symptoms in a sample of 1629 women, followed from pregnancy week seventeen to six months postpartum. Genotypes of ninety-four haplotype-tag single nucleotide polymorphisms (SNPs) in sixteen genes of the hypothalamus-pituitary-adrenal axis pathway were analyzed and data on psychosocial and demographic factors was collected. In sub-studies, salivary cortisol awakening response in gestational week 35–39, salivary evening cortisol levels in gestational week 36 and postpartum week 6, and blood cortisol and cortisone levels in gestational week 35–39 were analyzed. SNP-set kernel association tests were performed at the gene-level, considering psychosocial and demographic factors, followed by post-hoc analyses of SNPs of significant genes. Statistically significant findings at the 0.05 p-level included SNPs in the hydroxysteroid 11-beta dehydrogenase 1 (HSD11B1) gene in relation to self-rated depression scores in postpartum week six among all participants, and serpin family A member 6 (SERPINA6) gene at the same time-point among women with de novo onset of postpartum depression. SNPs in these genes also associated with stress hormone levels during pregnancy. The present study adds knowledge to the neurobiological basis of peripartum depression by systematically assessing SNPs in stress-regulatory genes and stress-hormone levels in a population-based sample of women.

Investigating the relationships between hypothalamic volume and measures of circadian rhythm and habitual sleep in premanifest Huntington's disease

ObjectivePathological changes within the hypothalamus have been proposed to mediate circadian rhythm and habitual sleep disturbances in individuals with Huntington’s disease (HD). However, investigations examining the relationships between hypothalamic volume and circadian rhythm and habitual sleep in individuals with HD are sparse. This study aimed to comprehensively evaluate the relationships between hypothalamic pathology and circadian rhythm and habitual sleep disturbances in individuals with premanifest HD. MethodsThirty-two individuals with premanifest HD and twenty-nine healthy age- and gender-matched controls participated in this dual-site, cross-sectional study. Magnetic resonance imaging scans were performed to evaluate hypothalamic volume. Circadian rhythm and habitual sleep were assessed via measurement of morning and evening cortisol and melatonin levels, wrist-worn actigraphy, the Consensus Sleep Diary and sleep questionnaires. Information on mood, physical activity levels and body composition were also collected. ResultsCompared to healthy controls, individuals with premanifest HD displayed significantly reduced grey matter volume in the hypothalamus, decreased habitual sleep efficiency and increased awakenings; however, no alterations in morning cortisol or evening melatonin release were noted in individuals with premanifest HD. While differences in the associations between hypothalamic volume and cortisol and melatonin output existed in individuals with premanifest HD compared to healthy controls, no consistent associations were observed between hypothalamic volume and circadian rhythm or habitual sleep outcomes. ConclusionWhile significant differences in associations between hypothalamic volume and cortisol and melatonin existed between individuals with premanifest HD and healthy controls, no differences in circadian markers were observed between the groups. This suggests that circadian regulation is maintained despite hypothalamic pathology, perhaps via neural compensation. Longitudinal studies are required to further understand the relationships between the hypothalamus and circadian rhythm and habitual sleep disturbances in HD as the disease course lengthens.

Abstract A53: Plasma glucocorticogenic activity differs by race/ethnicity and alcohol intake among San Francisco Bay Area women

Abstract Breast cancer mortality is higher among non-Hispanic Black (NHB) and Hispanic women than non-Hispanic White (NHW) women in the United States. While various sociodemographic and lifestyle factors contribute to racial/ethnic disparities in breast cancer, the biologic processes underlying these associations remain poorly understood. Cortisol, the predominant endogenous glucocorticoid present in humans, is secreted in a diurnal pattern with the highest concentration occurring shortly after waking followed by a steady decline throughout the day. A flattened diurnal cortisol pattern (e.g., due to lower morning and/or elevated evening cortisol levels) is often observed among chronically stressed individuals and has been linked to poorer survival among breast cancer patients. We examined the association between race/ethnicity and other breast cancer risk factors with glucocorticogenic (G) activity, a measure that reflects plasma cortisol levels, in 503 controls from the San Francisco Bay Area Breast Cancer Study (SFBCS, 329 Hispanic, 100 NHB and 74 NHW women) using a low-cost Chemical-Activated LUciferase gene eXpression (CALUX) assay. Associations between G activity and sociodemographic and lifestyle factors were examined using multivariable linear regression models. Hispanic and NHB women had 14% (P = 0.016) and 16% (P = 0.007) lower morning G activity than NHW women, respectively. Additionally, we replicated our previously reported association between G activity and alcohol intake (women who drank &amp;gt;10 gm had 22% higher G activity than non-drinkers, P = 0.003). This association was only present in Hispanics and NHB. No statistically significant associations were observed between G activity and Indigenous American ancestry, body mass index, or neighborhood socioeconomic status. Our results indicate that NHB and Hispanic women may have a blunted cortisol awakening response potentially due to chronic stress. The increase in morning G activity observed with higher alcohol intake in Hispanics and NHB might reflect the use of alcohol as a stress-coping mechanism. Further research should assess the association between G activity and breast cancer survival in biospecimens from a prospective cohort so as to characterize the relationship between prediagnosis chronic stress and breast cancer outcome across different racial/ethnic groups. Citation Format: Rosemarie M. de la Rosa, Sylvia S. Sanchez, Phum Tachachartvanich, Heather Ruiz, Scarlett Lin Gomez, Esther M. John, Martyn T. Smith, Laura Fejerman. Plasma glucocorticogenic activity differs by race/ethnicity and alcohol intake among San Francisco Bay Area women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A53.

RESISTANT HYPERTENSION IN MOOD DISORDERS AND SLEEP DISTURBANCES

Objective: A relationship between cardiovascular diseases and psychopathological symptoms has been described in the literature. However, few studies have reported mood disorders in patients with resistant hypertension (RH). We discuss a case of RH in a young otherwise healthy woman, and analyse the diagnostic and therapeutic approach followed.Design and method: A 52-year old woman referred to our Centre for hypertension (170/104 mmHg) uncontrolled by 10 mg/day amlodipine, 10 mg/day ramipril, 25 mg/day hydrochlorothiazide and 4 mg/day doxazozin. The 24h-ABPM showed a Reverse-Dipper profile of BP values (Figure 1). She referred a new onset diabetes, a rapid weight gain and new-onset personality disturbance with generalized anxiety, panic disorder, impairment of memory and asthenia for which she had been treated with sertraline 50 mg and alprazolam 1 mg daiy. She also had insomnia and alteration of dreams which became more bizarre and vivid. Physical examination showed central obesity, supraclavicular fat pads, moon facies with easy bruising and mild hirsutism. Results: Serum cortisol levels at the morning and at the evening and 24h-urinary free cortisol levels were increased (52.7/55.8 mcg/dL and 2450 μg respectively). Hypokalemia (2.6 mEq/L) was also found. A total-body TC scan (Figure 2) revealed a left adrenal gland mass (12 × 13 × 7.5 cm on size) and many nodular focal lesions in the liver suspected as replicating forms. A total body FDG-PET/CT scan (Figure 3) showed an increased uptake of the tracer (SUVmax 5.2) in the left adrenal gland with multiple liver metastases. Despite a therapy with ketoconazole and high doses of mitotane, 45 days after the admission the patient died for a cardio-circulatory arrest but autopsy was not performed by explicit family request. The clinical picture was suggestive for a primary adrenocortical carcinoma (ACC). Conclusions: ACC is a rare and aggressive malignant neoplasm often diagnosed at an advanced stage. The combination of Cushing's syndrome is frequently found, but psychopathological symptoms are rare at the onset of ACC. We suggest not to consider as «depressed» and not to treat with antidepressant agents a young hypertensive subject with resistant HT without having ruled out an organic cause of psychiatric disease.

Investigating daily fatigue scores during two-week offshore day shifts

ObjectivesThis study examined daily scores of fatigue and circadian rhythm markers over two-week offshore day shift periods. MethodsA prospective cohort study among N = 60 offshore day-shift workers working two-week offshore shifts was conducted. Offshore day shifts lasted from 07:00 – 19:00 h. Fatigue was measured objectively with pre- and post-shift scores of the 3-minute psychomotor vigilance tasks (PVT-B) parameters (reaction times, number of lapses, errors and false starts) and subjectively with pre- and post-shift Karolinska Sleepiness Scale (KSS) ratings. Evening saliva samples were collected on offshore days 2,7 and 13 to measure circadian rhythm markers such as dim-light melatonin onset times and cortisol. Generalized and linear mixed model analyses were used to examine daily fatigue scores over time. ResultsComplete data from N = 42 offshore day shift workers was analyzed. Daily parameters of objective fatigue, PVT-B scores (reaction times, average number of lapses, errors and false starts), remained stable over the course of the two-week offshore day shifts. Daily subjective post-shift fatigue scores significantly increased over the course of the two-week offshore shifts. Each day offshore was associated with an increased post-shift subjective fatigue score of 0.06 points (95%CI: .03 - .09 p < .001). No significant statistical differences in subjective pre-shift fatigue scores were found. Neither a circadian rhythm phase shift of melatonin nor an effect on the pattern and levels of evening cortisol was found. ConclusionDaily parameters of objective fatigue scores remained stable over the course of the two-week offshore day shifts. Daily subjective post-shift fatigue scores significantly increased over the course of the two-week offshore shifts. No significant changes in circadian rhythm markers were found. Increased post-shift fatigue scores, especially during the last days of an offshore shift, should be considered and managed in (offshore) fatigue risk management programs and fatigue risk prediction models.