Significant Increase In Cortisol Research Articles

The Serotonin Transporter Promoter Polymorphism Is Associated with Cortisol Response to Psychosocial Stress

Across multiple mental health-related measures, a polymorphism (5-HTTLPR) within the promoter of the serotonin transporter gene has been associated with differential psychological sensitivity to stressful experiences. Yet, the specific mechanisms by which this polymorphism contributes to risk for psychological dysfunction is unclear. Therefore, we investigated cortisol reactivity to psychosocial stress as a potential intermediate phenotype that might predispose to such risk. A psychologically healthy sample of 182 young adults were genotyped for the 5-HTTLPR. Each participant delivered a speech and performed mental arithmetic in one of three audience conditions: a critical evaluative audience, a supportive evaluative audience, or no audience. Salivary cortisol was sampled at baseline and at 20, 40, and 75 min after stressor onset. The two evaluative audience conditions elicited similar, significant increases in cortisol that were significantly greater than in the no audience control. Together, the evaluative audience conditions revealed a significant relationship between cortisol reactivity and the 5-HTTLPR, with the short/short genotype showing the greatest reactivity. Internal analyses revealed that the 5-HTTLPR was significantly associated with cortisol reactivity in the negative audience condition only, suggesting that short/short individuals might be especially vulnerable to social threat. The short/short genotype of the 5-HTTLPR is associated with greater cortisol reactivity to social threat. When short/short individuals experience stressful life events, they might be at greater risk for the adverse psychological and physical health consequences associated with heightened cortisol exposure.

Human cytomegalovirus productively infects adrenocortical cells and induces an early cortisol response

Following our recent findings on the presence of human cytomegalovirus (HCMV) in the normal human adrenal cortex and in adrenocortical tumors, especially in cortisol-secreting tumors, aim of the present study was to investigate the direct effects of HCMV infection on human adrenocortical cells. To this aim, both clinical isolates and laboratory strains of HCMV were used to assess the early effects of infection on human adrenocortical cell morphology, proliferation, gene expression, and steroidogenic function. Both clinical and laboratory HCMV strains could infect and replicate in primary human adrenocortical cell cultures and in adrenocortical carcinoma cell lines, leading to cytopathic changes. Most importantly, in the first hours post-infection (p.i.), adrenocortical cells showed a significant increase of cortisol and estrogen production, paralleled by up-regulation of steroidogenic acute regulatory protein and expression of steroidogenic enzymes involved in the last steps of adrenal steroidogenesis. This effect was probably due to HCMV immediate-early gene expression, since it was most evident in the early phases p.i. and UV-inactivated viral particles did not affect hormone production. Moreover, the effect on steroidogenesis was HCMV specific, since it was not observed after infection with herpes simplex virus. These data suggest that human adrenocortical cells are permissive to HCMV infection and acutely respond to infection with increased cortisol production. An acute glucocorticoid response is typically triggered by infections and is considered to be critical to host defense against pathogens, although, in the case of HCMV infection, it might also enhance viral replication and reactivation from latency.

Effects of guided immune-imagery: The moderating influence of openness to experience

It is widely believed that personality has an important role in determining the effectiveness of guided imagery (GI) interventions. The primary aim of the current study was to examine whether the effect of GI on several outcome measures was dependent upon openness to experience, a theoretically relevant variable previously unexplored as a potential moderator. Thirty-five healthy participants were randomised to an animated imagery, verbal imagery or no-intervention control group, with imagery groups receiving 10 × 20 min sessions. Pre/post-assessments of cortisol, sleep, stress and creativity were administered along with the openness to experience scale. Regression analysis indicated a significant increase in cortisol and decrease in tiredness following verbal GI, but only for those high in openness. The efficacy of GI interventions may be dependent upon openness to experience and this variable should be accounted for in future studies.

Long-term hypoxia enhances ACTH response to arginine vasopressin but not corticotropin-releasing hormone in the near-term ovine fetus

This study tested the hypothesis that long-term hypoxia (LTH) results in enhanced fetal corticotrope sensitivity to the ACTH secretagogues, corticotropin-releasing hormone (CRH), and AVP. Ewes were maintained at high altitude (3,820 m) from 40 to 130-131 days of gestation. Upon return to the laboratory, hypoxia was maintained by maternal nitrogen infusion. Vascular catheters were placed in both LTH (n = 4) and normoxic controls (n = 4). Each fetus received a 15-min infusion of either saline, 100 ng/kg of ovine CRH, or 20 ng/kg of AVP/min over 3 consecutive days in a randomized order. Fetal blood samples were collected at 0, 15, 30, 60, and 90 min after the start of infusion and analyzed for ACTH(1-39), ACTH precursors, and cortisol. Anterior pituitaries were collected from additional noninstrumented fetuses for analysis of vasopressin receptor 1b (V1b) mRNA and protein. Basal plasma concentrations of both ACTH(1-39) and ACTH precursors were higher in LTH fetuses and were not altered by saline infusion. In response to CRH, ACTH(1-39) increased in both groups and was higher in the LTH group compared with control (P < 0.05). When analyzed as sum of ACTH(1-39) released (Delta0-90 min) above basal, CRH released equal amounts of ACTH(1-39) in both groups. In LTH fetuses, AVP evoked a greater ACTH(1-39) release (P < 0.05) when analyzed as an increased sum of ACTH(1-39) (Delta0-90 min) above basal. Both CRH and AVP elicited a release of ACTH precursors with no differences observed between LTH and control. AVP and CRH elicited significant increases in cortisol, which were higher in response to AVP than CRH. V1b mRNA and protein were elevated in the anterior pituitary of LTH fetuses compared with control. LTH significantly increases pituitary sensitivity to AVP. This enhanced sensitivity may be a mechanism of our previously observed enhanced corticotrope function.

HIV-1 clade C infection and progressive disruption in the relationship between cortisol, DHEAS and CD4 cell numbers: A two-year follow-up study

Background It is well established that there is mutual interaction between the neuroendocrines and immune systems and that the disturbance in any one system could affect the function of the other. While there is a large body of evidence suggesting negative impact of human immunodeficiency virus type 1B (HIV-1B) infection on both immune and neuroendocrine systems, the consequence of HIV-1 clade C infection (with structural differences from HIV-1B virus) on these systems is not clearly understood. Methods We carried out a 2-year longitudinal study on plasma profile of adrenocorticosteroids, including cortisol and DHEAS and their relationship with declining CD4+ cell counts in neurologically asymptomatic HIV-C infected individuals ( N = 84) in order to understand the impact of HIV-1 clade C infection on adrenocortical dysfunction and its relationship with the progressive decline in the cell mediated immunity. Results We found that while plasma cortisol levels increased significantly at baseline in HIV-1C infected individuals compared to those in HIV-negative controls (HIV-1C+, 9.83 ± 0.39 vs controls, 8.04 ± 0.45; p < 0.01), there was a significant decrease in DHEAS in HIV-1C+ individuals, compared to that in HIV-negative controls (81.02 ± 4.9 vs 185.1 ± 12.03, p < 0.001), and consequently a significant increase in cortisol:DHEAS ratio in HIV-1 clade C infected persons (0.19 ± 0.002 vs control 0.058 ± 0.006; p < 0.001). Moreover, in HIV-1C infected individuals, there was a strong positive correlation between DHEAS and CD4 cells ( r = 0.2; p < 0.05), and a strong negative correlation between cortisol, as well as cortisol:DHEAS ratio and CD4 cells ( r = − 0.25; p < 0.01; and r = − 0.31; p < 0.001, respectively). Conclusions These findings suggest the persistent and progressive adrenocortical dysfunction during the asymptomatic phase of HIV infection, and that the evaluation of increase in plasma cortisol, a decrease in DHEAS, and an increase in cortisol:DHEAS ratio may serve as important biomarkers preceding the impending down regulation of CD4 cell counts and progressive decline in the immune system function in HIV-1C infection. Furthermore, these findings may indicate the dysregulation of 3β-hydroxysteroid dehydrogenase (3β-HSD) activity, the enzyme involved in the biosynthesis of cortisol and DHEA through the pregnenolone–progesterone pathway, and that it may offer an opportunity for drug discovery targeting re-regulation of 3β-HSD activity for potential therapeutic application in HIV-1C infection.

Social relationship as inducer of immunological and stress responses in matrinxã ( Brycon amazonicus)

Matrinxã ( Brycon amazonicus) is a freshwater neotropical fish species with a social interaction and aggressive behavior, especially in crowded environments. This species' social structure is established by agonistic interactions, which increase significantly at the fifth hour, when compared to the first and second hours of confinement, when each dominant fish competes with other individual for a conditioned territorialism. This social relationship also induces a complex physiological response in the organism, which generates an acute stimulation from the stressor agent. A stress situation modulates the physiology of the subordinate fish, which undergo significant increases in cortisol, glucose, hematocrit, and hemoglobin, when compared to the control fish. The immune system also indicates a modulation caused by cortisol, which results in an increase in neutrophils and a significant decrease in thrombocytes in subordinate fish, in comparison with control fish; however, the dominant fish show a significant increase in monocytes and a decrease in lymphocyte levels, when compared control fish. The agonistic interactions in B. amazonicus during crowding are not favorable to the physiology and immune system of the fish, mainly subordinate fish, and should be avoided in rearing systems.

Massage After Exercise-Responses of Immunologic and Endocrine Markers: A Randomized Single-Blind Placebo-Controlled Study

The effectiveness of massage for postexercise recovery remains unclear, despite numerous studies on this issue. The aim of this study was to determine the effect of massage on endocrine and immune functions of healthy active volunteers after intense exercise. After repeated Wingate tests, the effects of whole-body massage and placebo on salivary cortisol, immunoglobulin A (IgA), and total protein levels were compared using a between-group design. Sixty healthy active subjects (23 women, 37 men) underwent 2 exercise protocol sessions at least 2 weeks apart and at the same time of day. The first session familiarized participants with the protocol. In the second session, after a baseline measurement, subjects performed a standardized warm-up followed by three 30-second Wingate tests. After active recovery, subjects were randomly allocated to massage (40-minute myofascial induction) or placebo (40-minute sham electrotherapy) group. Saliva samples were taken before and after the exercise protocols and after recovery. In both groups, the exercise protocol induced a significant increase in cortisol (p < 0.001), decrease in salivary IgA (sIgA) (p < 0.001), and increase in total proteins (p = 0.01) in saliva. Generalized estimating equations showed a significant effect of massage on sIgA rate (p = 0.05), a tendency toward significant effect on salivary total protein levels (p = 0.10), and no effect on salivary flow rate (p = 0.55) or salivary cortisol (p = 0.39). The sIgA secretion rate was higher after the recovery intervention than at baseline among women in the massage group (p = 0.03) but similar to baseline levels among women in the placebo group (p = 0.29). Massage may favor recovery from the transient immunosuppression state induced by exercise in healthy active women, of particular value between high-intensity training sessions or competitions on the same day.

No Effect of 5-Day Treatment with Acetylsalicylic Acid (Aspirin) or the Beta-Blocker Propranolol (Inderal) on Free Cortisol Responses to Acute Psychosocial Stress: A Randomized Double-Blind, Placebo-Controlled Study

Background: The characterization of an individual’s hypothalamic-pituitary-adrenal axis stress response is a main research topic in neuropsychobiology since alterations have been causally linked to several disease states. Over the last years, several studies focused on the identification of sources of inter- and intraindividual variability, but there is still a paucity of experimental data on the effect of different pharmaceuticals on cortisol responses to acute psychological stress. Therefore, in this randomized double-blind placebo-controlled study, we investigated the effect of treatment with two popular and clinically used pharmaceuticals on stress-related cortisol responses, namely acetylsalicylic acid (aspirin), a known prostaglandin synthesis inhibitor, and the beta-blocker propranolol (Inderal), a nonselective beta-receptor antagonist. Methods: For 5 days, 73 healthy subjects (50 men, 23 women; mean age 47.3 ± 7.7 years) received either a daily oral dose of 100 mg aspirin, 80 mg propranolol (Inderal), aspirin + propranolol, or placebo. After treatment, subjects were confronted with the Trier Social Stress Test, a widely-used standardized psychosocial stress protocol. Cortisol responses were measured by six saliva samples taken before and after the stress exposure. Results: Subjects showed a significant cortisol increase after stress (p < 0.0001). The four treatment groups did not differ in their cortisol responses (group effect p > 0.44; interaction p > 0.97). Additionally, controlling for gender, age, smoking status, body mass index, mean arterial blood pressure or pre-stress cortisol levels yielded similar results in the total sample as well as in the male or female subgroups, respectively. Conclusion: Neither short-term treatment with aspirin nor propranolol altered the acute free cortisol response to psychological stress in healthy adults.

Neural Modulation of Endocrine Stress Response to Social Evaluation

Neural Modulation of Endocrine Stress Response to Social Evaluation

Maternal behavior predicts infant cortisol recovery from a mild everyday stressor

In the very first years of life, parenting is considered to be important for the regulation of the infant's emotional and physiological states. In the present study, three-month-old infants' cortisol responses (reactivity and recovery) to a mild everyday stressor, namely being taken out of the bath, were examined in relation to the quality of maternal behavior. It was hypothesized that a higher quality of maternal behavior towards the infant predicted lower cortisol reactivity as well as a better recovery from the reaction. The participants were 64 infants (34 boys and 30 girls) and their mothers. Maternal behavior (sensitivity and cooperation) towards the infant during the bathing routine was rated from videotapes. Salivary cortisol was obtained from the infants three times: before the bathing routine (T1), and 25 minutes (T2) and 40 minutes (T3) after the infants were taken out of the bath. The infants reacted with a significant increase in cortisol to the stressor (from 6.8 nmol/l to 9.9 nmol/l), and regression analysis showed that the higher the quality of maternal behavior the better the cortisol recovery from the stressor. Our findings indicate the potential importance of social processes for physiological recovery from everyday stressful situations in infants.

Hormonal responses during a prolonged military field exercise with variable exercise intensity

The purpose of the present study was to test the hypothesis that the magnitude of hormonal concentration alterations during a prolonged military field exercise with constant energy intake (EI) is influenced by changes in energy deficit (ED) induced by varying the exercise intensity. Basal serum hormone concentrations were measured in a group of healthy young male volunteers (n = 7) during a 20-day field exercise. During the first week of the exercise, the average ED was 4,000 kcal/day (P-I), in the second week only 450 kcal/day (P-II), and in the last week 1,000 kcal/day (P-III). During the first 5 days of the field exercise, significant increases in cortisol (COR, +32%) and growth hormone (GH, +616%) concentrations were observed, while insulin (INS, -70%), total testosterone (TES, -27%), free testosterone (TES(free), -26%) decreased. However, after these initial responses, COR and GH returned to the pre-exercise level by the beginning of P-II. Also TES and TES(free) recovered to the pre-exercise level by the beginning of P-III, and INS by the end of P-III. The concentration of TES (+29%) increased above the pre-exercise level by the beginning of P-III. Serum thyroxin (T(4)) concentration was significantly lesser (-12%) and urine urea concentration significantly higher (+78%) after the field exercise than before it. Therefore, it can be concluded that the lower levels of ED in the second and third phase (ED <1,000 kcal/day) allowed recovery of hormonal changes observed in the first phase with ED much greater than 1,000 kcal/day.

CSF cortisol in Alzheimer's disease and mild cognitive impairment

Hypercortisolaemia occurs in Alzheimer's disease (AD) and may be involved in the AD related neurodegenerative process. In order to determine whether brain structures are exposed to high cortisol concentrations early in AD, we measured cerebrospinal fluid (CSF) cortisol in 66 subjects with AD, 33 subjects with mild cognitive impairment (MCI) and 34 control subjects. CSF cortisol concentrations were higher in AD subjects compared to controls ( p < 0.001) and to MCI subjects ( p = 0.002). There was no significant increase of cortisol in MCI subjects compared with controls suggesting that the increase of CSF cortisol is not an early event in the course of AD.

Effects of Low- and High-Intensity Single-Leg Resistance Exercise on the MAPK ERK1/2 in Skeletal Muscle

PURPOSE: Acute resistance exercise signals responses in skeletal muscle to promote adaptations to the exercise stimulus, one of which is the mitogen-activated protein kinase pathway (MAPK). The purpose of this study was to determine the differential response of a prominent MAPK (ERK1/2) signal transduction pathway following a high-(HI) and a low-intensity (LI) bout of acute resistance exercise. METHODS: Thirteen subjects (21.54 ± 2.99 yr, 86.15±19.57 kg, 177.22±6.88 cm) completed a single-legged bout of HI (8–10 reps at 85% of 1-RM) and LI (18–20 reps at 65% of 1-RM) resistance exercise (leg press and leg extension) designed to reach muscular fatigue in a randomized, crossover design. Venous blood and muscle biopsies were obtained from each leg immediately before exercise (PRE), and at 30 minutes (30MPST), 2 hours (2HRPST), and 6 hours (6HRPST) following each resistance exercise sessions (RES), with an additional blood draw occurring at POST time point. Serum analyses included cortisol, insulin, GH, IGF-1, and IGFBP-3. Muscle analyses included phosphorylated IGF-1 R, MEK1, ERK1/2, and activated Elk-1. Statistical analyses utilized a 2×4 MANO VA for muscle variables and a 2×5 MANOVA for serum variables on delta responses (p>0.05). RESULTS: RES resulted significant increases in cortisol at 30MPST (p<0.001), GH at POST (p<0.001), insulin at POST (p<0.01), and IGFBP-3 at POST (p<0.001) in serum, with no significant differences observed between exercise intensities. RES resulted in significant increases in peak pIGF-1R at 6HRPST (p<0.05), pMEK1 at 2HRPST (p<0.001), pERK1/2 at 2HRPST (p<0.001), and Elk-1 at 6HRPST (p<0.001) from baseline levels in muscle. LI RES resulted in a significantly higher response in overall phosphorylation of IGF-1R (p<0.05) and Elk-1 activation (p<0.05) than the HI RES. CONCLUSIONS: These findings suggest that exercise intensity (as % of 1 -RM) is not as important in up-regulating the signal transduction response of the MAPK ERK1/2 pathway in skeletal muscle as once thought and that exercising to muscular fatigue may be a more important aspect of an acute exercise bout. Additionally, the observed higher volume of exercise in the low intensity group may be an important factor in up-regulating these signaling pathways.

A comparison of four methods of analgesia in cats following ovariohysterectomy

Objective To evaluate the effectiveness of preoperative administration of oral carprofen, subcutaneous ketoprofen, and local nerve block with bupivacaine in preventing postoperative pain-associated behavior in cats after ovariohysterectomy.Animals Fifty-two female intact cats.Materials and methods Cats received butorphanol (0.44 mg kg−1 IM), carprofen (2.2 mg kg−1 PO), ketoprofen (2.2 mg kg−1 SQ), or bupivacaine infiltration block (1.1 mg kg−1 SQ) before surgery. Cortisol and drug concentrations and visual analog scale (VAS) and interactive visual analog scale (IVAS) pain-associated behavior scores were measured 2 hours before and 0, 1, 2, 4, 8, 12, and 24 hours after ovariohysterectomy.Results Cats receiving butorphanol had significantly increased IVAS scores 2 hours after surgery compared with baseline measurements. Cats receiving carprofen, ketoprofen, and bupivacaine had significant increases from baseline in VAS and IVAS scores 1 and 2 hours after surgery. VAS and IVAS scores for cats receiving bupivacaine were significantly greater 1 and 2 hours after surgery than for cats that received butorphanol. Cats receiving carprofen had significant increases in cortisol 1 hour after surgery and significant decreases 24 hours after surgery compared with baseline measurements.Conclusions and clinical relevance Preoperative carprofen and ketoprofen have effects on pain-associated behavior similar to butorphanol in cats undergoing ovariohysterectomy. Cats receiving bupivacaine blocks may require additional analgesics immediately after surgery.

Hormone response to training and competition in athletic horses

It is recognised that the amount of psychological stress that an animal encounters determines the degree of response of the hypothalamic-pituitary-adrenal (HPA) axis. In human athletes, the added emotive stress of competition is an important element in the adrenal response. The aim of this study was to examine the effect of show-jumping as well as dressage on stress levels by comparing horses' stress response at a horse show compared to their familiar home. Fifty-one horses involved in competition were used. EDTA blood samples were collected before exercise, upon arrived to the schooling area (control), and k over a jump or dressage course. After sampling, plasma was separated and stored at -80 degrees C until determinations of cortisol and ACTH were performed. Fourteen healthy horses not involved in competition were used as control group. Competition induced a significant increase in cortisol and ACTH responses in both, jumping and dressage horses and this effect was more apparent in dressage horses. When horses were most experienced, cortisol and ACTH responses were much lower. This study shows that competition elicits a classic physiological stress response in horses and that different training programmes induce different responses. It suggests that horses involved in competition can provide a good model to study the exercise-induced stress response.

Effects of liquid carbohydrate/essential amino acid ingestion on acute hormonal response during a single bout of resistance exercise in untrained men

Objective The primary objective of this study was to investigate the influence of nutritive interventions on acute hormonal responses to a single bout of resistance exercise in untrained young men. Specifically, the aim was to determine whether the acute hormonal milieu conducive to enhancing skeletal muscle hypertrophic adaptation to resistance training could be created. The potential role of cortisol in inhibiting training-induced muscle growth is of particular interest, as is whether exercise-induced cortisol release can be attenuated by nutritive interventions. Methods After a 4-h fast, 32 subjects performed a single bout of resistance exercise (∼60 min), during which they consumed a 6% carbohydrate (CHO) solution, a 6-g essential amino acid (EAA) mixture, a combined CHO+EAA supplement, or a placebo beverage. Blood samples were collected every 15 min throughout the exercise bout, immediately after exercise, and 15 and 30 min after exercise for analysis of total testosterone, cortisol, growth hormone, insulin, and glucose. Results No significant change in glucose or insulin was observed for placebo. CHO and CHO+EAA ingestion resulted in significantly ( P < 0.001) increased glucose and insulin concentrations above baseline, whereas EAA resulted in significant postexercise increases ( P < 0.05) in insulin only. Placebo exhibited a significant increase in cortisol within 30 min ( P < 0.01), with a peak increase of 105% ( P < 0.001) immediately after exercise, and cortisol remained 54% above baseline at 30 min after exercise ( P < 0.05). Conversely, the treatment groups displayed no significant change in cortisol during the exercise bout, with CHO and CHO+EAA finishing 27% ( P < 0.01) and 23% ( P < 0.05), respectively, below baseline at 30 min after exercise. No between-group differences in exercise-induced growth hormone or testosterone concentrations after nutritive intervention were present. Conclusion These data indicate that CHO and/or EAA ingestion during a single bout of resistance exercise suppresses the exercise-induced cortisol response, in addition to stimulating insulin release. We conclude that the exercise-induced hormonal profile can be influenced by nutritive interventions toward a profile more favorable for anabolism.

Subjective social status moderates cortisol responses to social threat

Research has demonstrated a robust relationship between social status, physiology and health in humans and animals. However, perceptions of social status within a specific social group have rarely been studied in this area and may provide additional relevant information. The current investigation examines subjective perceptions of social status as a moderator of cognitive, emotional and cortisol responses to stressor tasks characterized by social-evaluative threat or its absence. As part of a larger study, 81 college students living in a residential dormitory completed a measure of their subjective perceptions of their social status within their dormitory floor. They were randomly assigned to undergo a standard performance stressor task either with or without social evaluation. It was hypothesized that individuals who perceived that they were of low status within their dorm group would show greater increases in negative self-evaluative emotions (i.e., shame) and cognitions (low social self-esteem) and greater cortisol responses to the stressor under conditions of social-evaluative threat. Subjective social status moderated cortisol responses to the social-evaluative stressor, but in a direction opposite that hypothesized. Individuals who perceived themselves to be of high status showed sizable and significant cortisol increases (both peak and recovery), while those who perceived themselves to be of low status did not mount a significant cortisol response to the stressor. Both groups showed increased negative self-evaluative responses to the tasks. A discussion of the possible health implications of the robust cortisol responses of high status individuals and the hyporesponsive cortisol reactions of low status individuals is provided.

Effects of a long-distance run on cardiac markers in healthy athletes

Running a marathon is a stressful event for athletes. Limited research exists on the role of cardiac markers during such a strenuous event. The aim of this study was to investigate detailed changes in cardiac markers before and after a long-distance run. We studied 25 male and 2 female runners (age 34-64 years) who were running the Visé-Maastricht-Visé marathon. Blood samples were drawn just before and immediately after finishing the marathon. An additional blood sample was collected 24 h later. Running the marathon led to a significant increase in cortisol. This returned to baseline values 24 h after the marathon. There was a slight increase in brain natriuretic peptide (BNP); however, this was not statistically significant. On the contrary, the N-terminal fragment of BNP (NT-pro-BNP) was significantly increased immediately after the run and was normalized 24 h later in 26 out of 27 runners (96%). The magnitude of the transient elevations in BNP and NT-pro-BNP increased with the age of the athletes. Furthermore, in 9 out of 27 runners there was a significant increase in troponin T. However, in all these runners this increase was transient and troponin-T levels returned to baseline values 24 h after the marathon. Running a marathon significantly increases NT-pro-BNP levels in healthy adults. This increase could be partially attributed to cardiac stress. The transient increases in BNP, NT-pro-BNP and troponin T are more likely to reflect myocardial stunning than cardiomyocyte damage. It seems that the magnitude of the increase in BNP could serve as a marker of the biological age of the myocardium.

The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux

Objective Using an experimental paradigm this investigation explored whether exposure to psychological stress would produce a significant increase in acid-reflux episodes or modify subjective perceptions of gastro-oesophageal reflux (GOR) symptoms. Methods Forty-two patients presenting with heartburn and acid regurgitation underwent 24-h oesophageal pH monitoring. During the last 90 min of this monitoring period, 21 patients received a psychological stressor, while the remaining participants were randomly assigned to a no-stress control condition. State anxiety and subjective GOR symptom ratings were obtained 1 min pretest, 1 min posttest, and 40 min posttest. Cortisol samples were collected at 10-min intervals. Results The stressor induced a significant increase in cortisol and state anxiety; however, this was not associated with any increase in reflux. Instead, the experimental group reported a dissociation between objectively measured reflux episodes and subjective symptom ratings. A similar pattern was established for participants who reported greater state anxiety, produced larger cortisol responses, or exhibited certain stress-related personality characteristics. Conclusion The perception of symptoms in the absence of increased reflux when one is stressed may account for low response rates to traditional treatments. This highlights a need to bridge the gap between psychosomatic research and clinical practice to develop more successful GOR therapies.

New Criteria for Irritable Bowel Syndrome Based on Prospective Symptom Evaluation

In a population prevalence questionnaire study we demonstrated that constipation and fecal incontinence are common problems in the general Swedish population with a similar magnitude as in other Western countries. 95.6% of the population had between three bowel movements per day and three per week. Constipation was mostly defined by “hard stools” and “the need of using laxatives”. Irritable Bowel Syndrome (IBS) is characterized by abdominal pain/discomfort and abnormal bowel habits. The diagnostic criteria of IBS are based on clinical symptoms. Division of IBS patients into symptom subgroups appears important as their bowel symptoms are characterized by heterogeneity. International criteria to subgroup IBS (Rome II) are based on expert consensus and not on evidence. We investigated the variation of stool consistency and defecatory symptoms in 135 IBS patients by symptom diary cards. Most patients had alternating stool consistency. When subgroups were based on stool consistency, all kinds of defecatory symptoms (straining, urgency, and feeling of incomplete evacuations) were frequently present in all subgroups. Stool frequency was in the normal range in the majority of patients. We propose that IBS subgroups should be based on stool consistency. We suggest that Rome II supportive criteria must be reconsidered as the determination of presence or absence of specific symptoms does not work as an instrument for categorization of IBS patients into diarrhoea- and constipation-predominant. We also propose that abnormal stool frequency should be excluded to define subgroups of IBS. Alternating stool consistency and presence of different defecatory symptoms, regardless of stool consistency should be included as criteria for IBS. Stress is known to play an important role in the onset and modulation of IBS symptoms. From experimental studies there is evidence for a stress-dependent alteration of visceral sensitivity. The biological mechanisms responsible for the causal link between stress and IBS symptoms are not completely understood, but the hypothalamic-pituitary-adrenocortical axis and the autonomous nervous system seem to play a prominent role in the pathophysiology of IBS. We investigated visceral sensitivity and the effect of repeated maximal tolerable rectal distensions on salivary cortisol levels and skin conductance in patients with IBS, chronic constipation and healthy volunteers. We found that the expectancy of the experimental situation per se (provocation of bowel symptoms by rectal distensions) compared to non-experimental days at home measured as salivary cortisol had a high impact on the level of arousal in IBS. IBS patients had higher skin conductance values than controls in the beginning of distension series and lower rectal thresholds for first sensation, urge and discomfort than healthy controls and constipation patients. IBS patients demonstrated habituation to repeated subjective maximal tolerable rectal distensions according to sympathetic activity although patients continued to rate their discomfort as maximal. Constipation patients had lower sympathetic activity than IBS patients before and during repeated rectal distensions. None of the groups demonstrated a significant increase in cortisol after repetitive rectal distensions. We conclude that Rome II supportive criteria for IBS should be reconsidered according to our findings. IBS patients are more sensitive to pre-experimental stress than healthy controls and patients with constipation. This should be considered in the design of experimental IBS studies. IBS patients habituated to subjective maximal tolerable, repetitive rectal distensions with decreasing sympathetic activity. Since responses to repeated stimuli of close-to-pain intensities are resistant to habituation this finding could be caused by psychological influences on perception, that is, perceptual response bias.