Abstract
Background: Considerable research implicates over-activity of the hypothalamic-pituitary
adrenal axis in the pathophysiology of adult mood and anxiety disorders. The current
study evaluates the association between salivary cortisol concentrations and response
to carbon-dioxide inhalation in children and adolescents with anxiety disorders, mood
disorders, or no psychiatric illness. The central question was whether response to
carbon-dioxide inhalation is associated with levels of hypothalamic-pituitary adrenal
axis activation. If confirmed, this would relate hypothalamic-pituitary adrenal axis
activation in juveniles, as in adults, and response to a well-studied respiratory
procedure.
Methods: Serial salivary cortisol samples were examined in 98 subjects (ages 9–17
years), including 62 subjects with an anxiety and/or mood disorder and 36 nonpsychiatrically
ill comparisons. Samples were obtained upon arrival at the laboratory, following a
tilt test, then before and immediately after a standard 5% carbon dioxide inhalation
procedure.
Results: Salivary cortisol levels pre-carbon-dioxide inhalation were significantly
higher in patients sensitive to the anxiogenic effects of carbon dioxide (n = 20) than in patients who did not respond to carbon dioxide (n = 42) and in healthy subjects, none of whom were sensitive to carbon dioxide (n = 36); cortisol concentrations in the latter two groups were indistinguishable. Salivary
cortisol did not increase during carbon-dioxide inhalation, irrespective of diagnostic
group or degree of reactivity to the procedure.
Conclusions: The current data resemble data from studies of laboratory-induced panic
among adult patients. In both groups, activation of the hypothalamic-pituitary adrenal
axis is associated with the response to a standardized stressor. Similarly, as in
adults, carbon-dioxide inhalation in juveniles does not produce a significant change
in hypothalamic-pituitary adrenal axis activation.
Keywords
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Article info
Publication history
Accepted:
July 9,
2001
Received in revised form:
June 27,
2001
Received:
March 13,
2001
Identification
Copyright
© 2002 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
