Responsiveness of cortisol and dehydroepiandrosterone to ACTH in children

Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke

OBJECTIVE

Elevated cortisol levels are associated with confusion and poor outcome after stroke. Dehydroepiandrosterone sulphate (DS), the most abundant adrenal androgen may act as an anti-glucocorticoid. An altered regulation of these steroids may affect numerous brain functions, including neuronal survival. The purpose of this study was to investigate serum cortisol and DS levels and the cortisol/DS ratio early after stroke and relate our findings to the presence of disorientation and mortality.

DESIGN

Patients with acute ischaemic stroke (n = 88, 56 men and 32 women) admitted to a stroke unit were investigated with repeated clinical assessments and scores for degree of confusion, extent of paresis and level of functioning. Serum cortisol (C) and DS were measured on day 1 and/or day 4. Data for 28-day and 1-year mortality are presented. A control group of 65 age-matched healthy individuals was used. Multivariate analyses of mortality rates in the different tertiles or sixtiles of serum cortisol were performed with logistic regression, adjusting for age, sex, diabetes and level of consciousness.

RESULTS

There was no difference in serum cortisol levels on day 1 for stroke patients when compared with control group values. Initial cortisol levels were significantly higher in the patients with acute disorientation versus orientated patients (P < 0.05). Cortisol levels on day 1 were an independent predictor of 28-day mortality, and patients with low cortisol levels (<270 nmol L(-1)) and increased levels (>550 nmol L(-1)) both had an increased 1-year mortality. DS levels on day 1 were significantly elevated in stroke patients.

CONCLUSION

Hypercortisolism is associated with cognitive dysfunction early after ischaemic stroke. High and low circulating cortisol levels are associated with increased mortality after stroke. DS levels were not associated with clinical outcome.

The early dehydroepiandrosterone sulfate rise of adrenarche and the delay of pubarche indicate primary ovarian failure in Turner syndrome

Pubarche without thelarche has been taken as clinical evidence that adrenarche is independent of gonadarche in females. This study examines whether the course of adrenarche [rise of serum dehydroepiandrosterone sulfate (DHEAS)] and pubarche (Tanner stage PH2) is independent from ovarian function. Serum DHEAS levels (n = 867) were longitudinally measured in 111 girls with Turner syndrome between 1990 and 2002. Of these, 22 had spontaneous puberty onset (Tanner stage B2), and 45 had primary ovarian failure (POF). Serum DHEAS levels were assayed by chemiluminescence and compared with those of healthy girls (n = 322; age range, 3-17 yr in both groups). Between the ages of 7 and 17 yr, girls with Turner syndrome had significantly higher age-related DHEAS levels than normal girls (P </= 0.02). Moreover, in the 9- to 15-yr-old girls, DHEAS levels were significantly higher in girls with Turner syndrome and POF than in Turner syndrome girls with spontaneous puberty onset (P </= 0.02). This discrepancy was caused by an earlier adrenarche (DHEAS levels reaching 1.1 micro mol/liter) in Turner syndrome girls with POF, which occurred at a median age of 8.3 yr (80% confidence interval, 6.5-10.4 yr) vs. 10.5 yr (8.6-12.2) and 11.0 yr (8.9-12.6) in Turner syndrome girls with spontaneous puberty onset and normal girls, respectively (P = 0.003). In contrast, pubarche was delayed in Turner syndrome girls with POF [median age, 13.0 yr (80% confidence interval, 10.6-15.0) vs. 11.9 yr (10.5-13.2) in Turner syndrome girls with spontaneous puberty onset (P = 0.02) and 11.6 yr (10.6-12.5) in normal girls]. Primary gonadal failure in Turner syndrome is associated with an earlier onset of adrenarche, but delayed pubarche. These data demonstrate that normal timing of adrenarche is dependent on gonadal function and suggest that normal pubarche is the clinical manifestation of the ovarian conversion of DHEAS to active androgens.

The adolescent brain and age-related behavioral manifestations

To successfully negotiate the developmental transition between youth and adulthood, adolescents must maneuver this often stressful period while acquiring skills necessary for independence. Certain behavioral features, including age-related increases in social behavior and risk-taking/novelty-seeking, are common among adolescents of diverse mammalian species and may aid in this process. Reduced positive incentive values from stimuli may lead adolescents to pursue new appetitive reinforcers through drug use and other risk-taking behaviors, with their relative insensitivity to drugs supporting comparatively greater per occasion use. Pubertal increases in gonadal hormones are a hallmark of adolescence, although there is little evidence for a simple association of these hormones with behavioral change during adolescence. Prominent developmental transformations are seen in prefrontal cortex and limbic brain regions of adolescents across a variety of species, alterations that include an apparent shift in the balance between mesocortical and mesolimbic dopamine systems. Developmental changes in these stressor-sensitive regions, which are critical for attributing incentive salience to drugs and other stimuli, likely contribute to the unique characteristics of adolescence.

Serum dehydroepiandrosterone sulfate in a normal pediatric population

Dehydroepiandrosterone sulfate (DHAS) was measured in serum from 274 children and adolescents aged 1 month to 18.7 years, and in 38 healthy adults. In the pediatric group, which comprised 131 males and 143 females, serum DHAS was markedly age-dependent. Values declined between 1 and 5 months after birth, but were generally less than 4 mumol/L. Between 6 months and 7 years DHAS was less than 0.5 mumol/L in boys and less than 1.0 mumol/L in girls. Above 8 years DHAS progressively increased in both sexes to less than 13 mumol/L in mid-late teenage males and less than 12 mumol/L in females of the same age, similar to the values observed in the adults. In children and adolescents over 10 years, there was considerable overlap in DHAS values between groups of children classified by pubertal stage, resulting from the dissociation between adrenal and gonadal development during normal puberty.