The CIRCORT database: Reference ranges and seasonal changes in diurnal salivary cortisol derived from a meta-dataset comprised of 15 field studies

Diurnal salivary cortisol profiles are valuable indicators of adrenocortical functioning in epidemiological research and clinical practice. However, normative reference values derived from a large number of participants and across a wide age range are still missing. To fill this gap, data were compiled from 15 independently conducted field studies with a total of 104,623 salivary cortisol samples obtained from 18,698 unselected individuals (mean age: 48.3 years, age range: 0.5–98.5 years, 39% females). Besides providing a descriptive analysis of the complete dataset, we also performed mixed-effects growth curve modeling of diurnal salivary cortisol (i.e., 1–16 h after awakening). Cortisol decreased significantly across the day and was influenced by both, age and sex. Intriguingly, we also found a pronounced impact of sampling season with elevated diurnal cortisol in spring and decreased levels in autumn. However, the majority of variance was accounted for by between-participant and between-study variance components. Based on these analyses, reference ranges (LC/MS–MS calibrated) for cortisol concentrations in saliva were derived for different times across the day, with more specific reference ranges generated for males and females in different age categories. This integrative summary provides important reference values on salivary cortisol to aid basic scientists and clinicians in interpreting deviations from the normal diurnal cycle

Psychologie bei Diabetes : Erkennen Sie Angststörungen und diabetesbezogene Ängste?

Lernziele: Durch die Lektüre dieser Lerneinheit ... erfahren Sie, welche Formen pathologischer Ängste der neuen S2-Leitlinie „Psychologie und Diabetes“ der Deutschen Diabetes Gesellschaft zufolge unterschieden werden, wissen Sie, woran man sie erkennen kann und was bei Verdacht darauf getan werden kann, um den betroffenen Patienten zu helfen. Eine gewisse Furcht vor der chronischen Erkrankung Diabetes und ihren Folgen ist angemessen und hilft mitunter, sich konsequent um die eigene Therapie zu bemühen. Völlige Sorglosigkeit kann ebenso zum Problem werden wie übertriebene Angst, die die Lebensqualität vermeidbar einschränkt. Hier gilt es gegenzusteuern. Die S2-Leitlinie „Psychosoziales und Diabetes“ der Deutschen Diabetes-Gesellschaft bietet Entscheidungshilfen für Diagnostik und Therapie

Pituitary-adrenal and sympathetic nervous system responses to stress in women remitted from recurrent major depression

Objective: To better understand the changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) function after remission of depression. We characterized these systems at baseline and in response to a psychosocial stressor in a cohort of women remitted from recurrent major depression as well as in never-depressed healthy female controls. Methods: Baseline HPA function was measured via saliva cortisol sampling at 8 AM and 4 PM over 7 days as well as quantification of urinary overnight cortisol secretion. The HPA system response to a psychosocial stressor was assessed by measuring serum cortisol and adrenocorticotropic hormone (ACTH) levels and SNS reactivity by determining serum epinephrine (E) and norepinephrine (NE) concentrations as well as autonomic nervous system changes by analysis of heart rate variability (HRV). The stressor included a speech task, mental arithmetic, and a cognitive challenge. Results: In all, we studied 22 women remitted from recurrent major depression (age 51.0 +/- 1.7 years) and 20 healthy controls (age = 54.2 +/- 1.6 years). Morning saliva cortisol concentrations were lower in remitted patients, paralleled by lower serum cortisol concentrations before stress testing. This group also displayed a blunted cortisol and ACTH response to the stressor, as compared with healthy controls. No between-group differences in HRV parameters were observed. Conclusion: In this group of women remitted from recurrent major depressive disorder, we found evidence of HPA system hypoactivity, both in the basal state and in response to a psychosocial stressor

No association between cardiometabolic risk and neural reactivity to acute psychosocial stress

Background: Exaggerated reactivity to acute psychosocial stress is associated with an increased risk of cardiovascular and metabolic disease. A dysfunction of the cortico-limbic network coordinating the peripheral adaptation to acute stress exposure may constitute a brain mechanism underlying this association. We opted to characterize the changes of this network associated with acute psychosocial stress exposure in individuals with low and high cardiometabolic risk (CMR). Methods: In 57 subjects without overt cardiac or cerebral disease, the Framingham risk score and presence/absence of type 2 diabetes or metabolic syndrome defined CMR. Psychosocial stress was induced during functional magnetic resonance imaging (fMRI) of brain activity by an established social threat paradigm. Measurements of heart rate, blood pressure and saliva cortisol quantified the peripheral stress reaction. Regression analyses for the anterior cingulate cortex, hippocampus, amygdala, insula and regulatory prefrontal regions evaluated the association of stress-associated brain activation and CMR. Results: Psychosocial stress exposure was associated with an increased activity of a brain network including anterior and posterior cingulate cortex, putamen, insula, parahippocampus and right hippocampus. Psychosocial stress-associated brain activation did neither covary with Framingham risk score nor differ between groups with low or high CMR. Conclusion: Exposure to acute psychosocial stress induces the activation of a well-defined cortico-limbic network. However, we did not find an association between CMR and this network's stress reactivity. Keywords: Psychosocial stress, fMRT, Cortico-limbic, Cardiovascular, Type 2 diabetes, Framingham risk scor