Comparison of salivary cortisol as measured by different immunoassays and tandem mass spectrometry

"What's yours is mine": Partners' everyday emotional experiences and cortisol in older adult couples

The existing literature consistently finds that emotional experiences and cortisol secretion are linked at the within-person level. Further, relationship partners tend to covary in emotional experience, and in cortisol secretion. However, we are only beginning to understand whether and how an individuals' emotions are linked to their relationship partners' cortisol secretion. In this project, we harmonized data from three intensive measurement studies originating from Canada and Germany to investigate the daily dynamics of emotions and cortisol within 321 older adult couples (age range=56-87 years). Three-level multilevel models accounted for the nested structure of the data (repeated assessments within individuals within couples). Actor-Partner Interdependence Models were used to examine the effect of own emotional experiences (actor effects) and partner emotional experiences (partner effects) on momentary and daily cortisol secretion. Adjusting for age, sex, education, comorbidities, assay version, diurnal cortisol rhythm, time spent together, medication, and time-varying behaviors that may increase cortisol secretion, results suggest that higher relationship partner's positive emotions are linked with lower momentary cortisol and total daily cortisol. Further, this association was stronger for older participants and those who reported higher relationship satisfaction. We did not find within-couple links between negative emotions and cortisol. Overall, our results suggest that one's relationship partner's positive emotional experience may be a protective factor for their physiological responding, and that these more fleeting and day-to-day fluctuations may accumulate over time, contributing to overall relationship satisfaction.

Cortisol sensing by optical sensors

During a stress condition, the human body synthesizes catecholamine neurotransmitters and specific hormones (called "stress hormones"), the most important of which is cortisol. The monitoring of cortisol levels is extremely important for controlling the stress levels. For this reason, it has important medical applications. Common analytical methods (HPLC, GC-MS) cannot be used in real life due to the bulkiness of the instruments and the necessity of specialized operators. Molecular probes solve this problem. This review aims to provide a description of recent developments in this field, focusing on the analytical aspects and the possibility to obtain real practical devices from these molecular probes.

Does stress induction affect cognitive performance or avoidance of cognitive effort?

Previous research has shown that acute psychosocial stress impairs cognitive abilities, but recent studies suggest that this may be due to a decrease in willingness to engage in cognitive effort rather than a direct effect on performance. The aim of the present study was to replicate this last research and verify the influence of acute stress on avoidance of cognitive effort and cognitive performance. Fifty young, healthy individuals (26 females, 24 males) aged between 18 and 40 years were randomly assigned to two groups: a stress condition and a control condition. We used a Demand Selection Task paradigm (DST), in which participants chose between performing tasks that required either high or low cognitive effort. Stress was induced through the Trier Social Stress Test (TSST) and measured with both subjective and psychophysiological measurements. The results indicated that acute stress significantly increased participants' preference for less demanding behaviors, while no significant alterations in cognitive performance in task change activities were found. This study offers new perspectives on how stress affects behavior and decision-making in everyday life.

Recent advances in aptamer-based platforms for cortisol hormone monitoring

The stressful conditions of today-life make it urgent the timely prevention and treatment of many physiological and psychological disorders related to stress. According to the significant progress made in the near future, rapid, accurate, and on-spot measurement of cortisol hormone as a dominant stress biomarker using miniaturized digital devices is not far from expected. With a special potency in the fields of diagnosis and healthcare monitoring, aptamer-mediated biosensors (aptasensors) are promising for the quantitative monitoring of cortisol levels in the different matrices (sweat, saliva, urine, cerebrospinal fluid, blood serum, etc.). Accordingly, this in-depth study reviews the superior achievements in the aptasensing strategies to detect cortisol hormone with the synergism of diverse two/three dimensional nanostructured materials, enzymatic amplification components, and antibody motifs. The represented discussions offer a universal perspective to achieve lab-on-chip aptasensing arrays as future user-friendly skin-patchable electronic gadgets for on-site and real-time quantification of cortisol levels.

Testosterone histories from tusks reveal woolly mammoth musth episodes

Hormones in biological media reveal endocrine activity related to development, reproduction, disease and stress on different timescales¹. Serum provides immediate circulating concentrations², whereas various tissues record steroid hormones accumulated over time^3,4. Hormones have been studied in keratin, bones and teeth in modern^5-8 and ancient contexts^9-12; however, the biological significance of such records is subject to ongoing debate^10,13-16, and the utility of tooth-associated hormones has not previously been demonstrated. Here we use liquid chromatography with tandem mass spectrometry paired with fine-scale serial sampling to measure steroid hormone concentrations in modern and fossil tusk dentin. An adult male African elephant (Loxodonta africana) tusk shows periodic increases in testosterone that reveal episodes of musth^17-19, an annually recurring period of behavioural and physiological changes that enhance mating success^20-23. Parallel assessments of a male woolly mammoth (Mammuthus primigenius) tusk show that mammoths also experienced musth. These results set the stage for wide-ranging studies using steroids preserved in dentin to investigate development, reproduction and stress in modern and extinct mammals. Because dentin grows by apposition, resists degradation, and often contains growth lines, teeth have advantages over other tissues that are used as records of endocrine data. Given the low mass of dentin powder required for analytical precision, we anticipate dentin-hormone studies to extend to smaller animals. Thus, in addition to broad applications in zoology and palaeontology, tooth hormone records could support medical, forensic, veterinary and archaeological studies.

Day-to-day coordination of the stress and reproductive axes: A continuous-time analysis of within-person testosterone and cortisol relationships in athletic and healthy men

Day-to-day coordination of the stress (i.e., hypothalamic-pituitary-adrenal [HPA]) and reproductive (i.e., hypothalamic-pituitary-gonadal [HPG]) axes is central to allostatic regulation, reproductive success, and survival. Reports of positive, within-person testosterone and cortisol relationships (or coupling) suggest cross-talk of a facilitative nature, but longitudinal evidence is scarce and has methodological and analytical limitations. To address this, we used a continuous-time (CT) model to investigate day-to-day, within-person coupling of testosterone and cortisol in two male cohorts. Salivary testosterone and cortisol fluctuations were monitored in 35 athletic men across two international tournaments (M = 19.3 tests) and in 41 healthy men during normal daily living (M = 27.9 tests). Bayesian CT analysis revealed a diminishing effect of each hormone on itself as time-interval length or lag increased. In both groups, cortisol had a negative lagged effect on testosterone that persisted for around three days. The cortisol effect on testosterone peaked after 0.71 and 0.51 days in athletic (standardized estimate = -0.13) and healthy men (standardized estimate = -0.11), respectively. Further estimates of non-lagged, contemporaneous correlations revealed positive testosterone and cortisol relationships (athlete r = 0.04, healthy r = 0.46). In summary, complex within-person HPA and HPG interplay emerged in two independent male cohorts. Specifically, a rising cortisol concentration was linked to a fall in testosterone concentration at later time points, but concurrently these hormones tended to rise and fall together. Our results suggest that inhibitory and facilitatory hormonal actions coexist on varying timescales, thereby expanding knowledge of HPG and HPA cross-talk in everyday life.

Pitfalls in the Diagnosis and Management of Hypercortisolism (Cushing Syndrome) in Humans; A Review of the Laboratory Medicine Perspective

Biochemical confirmation of a diagnosis of hypercortisolism (Cushing syndrome) is vital to direct further investigations, especially given the overlap with non-autonomous conditions, such as pseudo-Cushing, and the morbidity associated with missed diagnoses. A limited narrative review was performed focusing on the laboratory perspective of the pitfalls of making a biochemical diagnosis of hypercortisolism in those presenting with presumed Cushing syndrome. Although analytically less specific, immunoassays remain cheap, quick, and reliable in most situations. Understanding cortisol metabolism can help with patient preparation, specimen selection (e.g., consideration of urine or saliva for those with possible elevations of cortisol binding globulin concentration), and method selection (e.g., mass spectrometry if there is a high risk of abnormal metabolites). Although more specific methods may be less sensitive, this can be managed. The reduction in cost and increasing ease of use makes techniques such as urine steroid profiles and salivary cortisone of interest in future pathway development. In conclusion, the limitations of current assays, particularly if well understood, do not impede diagnosis in most cases. However, in complex or borderline cases, there are other techniques to consider to aid in the confirmation of hypercortisolism.

Physical Activity and Cortisol Regulation: A Meta-Analysis

Physical activity participation is associated with effective stress coping, indicated by decreases in both physiological stress reactivity and perceived stress. Quantifying the effect of physical activity on the diurnal regulation of one key physiological stress indicator, the stress hormone, cortisol, across studies may demonstrate the extent to which physical activity participation is associated with diurnal HPA axis regulation. We meta-analyzed studies examining relations between physical activity participation and indices of HPA axis regulation: the diurnal cortisol slope and the cortisol awakening response. We also examined moderators of the relation. The analysis revealed a small, non-zero negative averaged correlation between physical activity and the diurnal cortisol slope (r = -0.043, 95% CI [-0.080, -0.004]). Examination of sample sociodemographic differences, study design characteristics, cortisol measurement methods, and physical activity variables as moderators revealed few effects on the relation between physical activity and diurnal cortisol slope. We did not observe lower levels of variability in the mean cortisol awakening response at higher levels of physical activity participation, and moderator analyses showed little evidence of reductions in heterogeneity for this effect. We found some evidence of systematic publication bias. Findings suggest higher physical activity is associated with a steeper diurnal cortisol slope. However, the cortisol awakening response did not differ by physical activity level. Future studies testing the physical activity and cortisol regulation association should use standardized physical activity measures, follow guidelines for better quality cortisol sampling collection and analysis, and test relations in large-scale empirical studies to confirm the direction and causality of the effect.

Teachers' situational physiological stress and affect

Since teaching is a demanding and stressful profession, the study of teachers' physiological stress in the classroom setting is an emerging field. In cross-sectional studies self-reported stress and affect are related, but less is known about the intraindividual relations between situational physiological stress and corresponding positive and negative affect. The aim of our study was to investigate the associations between situational physiological stress (six salivary cortisol samples per day) and self-reported situational affect (Positive and Negative Affect Schedule four times a day) among 61 Finnish primary school teachers over two workdays. We present a novel multilevel structural equation model (MSEM) that includes cortisol, with time since awakening as a flexibly coded time-varying covariate and affect with time since cortisol measurement as a time-varying covariate. Higher levels of teachers' situational physiological stress were related to lower situational positive affect (e.g., enthusiasm) and higher negative affect (e.g., nervousness), demonstrating the acute/situational effects of stress on affect. In our discussion, we emphasize the importance of the sequence of sampling and observations for further theoretical modeling of relations between stress and affect. We also propose practical implications for improving teachers' awareness of their well-being.

Teachers' daily physiological stress and positive affect in relation to their general occupational well-being

BACKGROUND

Teachers' stress, affect and general occupational well-being influence their teaching and their students. However, how teachers' daily physiological stress and positive affect are related in the classroom is unknown. To reduce teachers' stress and enhance their positive affect, it is crucial to understand how occupational well-being relates to stress and affect.

AIM

The aim of the study was to examine the relationships between teachers' daily physiological stress and positive affect in authentic classroom settings and the roles played by teachers' self-efficacy beliefs, perceptions of school climate and burnout symptoms in daily stress and affect.

SAMPLE

The sample consisted of 45 classroom teachers.

METHOD

Daily physiological stress was assessed by measuring salivary cortisol levels three times in two days. Positive affect was reported by experience sampling at the same time that cortisol was collected. Questionnaires were used to assess self-efficacy beliefs, perceptions of school climate and burnout symptoms. Three-level modelling with random intercepts and slopes was used to analyse the relationships between daily stress and affect and the effect of teachers' general occupational well-being on stress and affect.

RESULTS

No relationships were evident between teachers' physiological stress and positive affect or between daily changes of stress and affect. Self-efficacy beliefs were related to lower stress and higher affect in the middle of the school day. Having sufficient school resources were related to higher positive affect. Teachers' burnout symptoms were associated with lower positive affect.

CONCLUSIONS

We emphasize the potential for self-efficacy and perceptions of school resources as targets for intervening in teachers' stress and affect.

The effects of music intervention on anxiety and stress responses in adults with CHD undergoing cardiac catheterisation

INTRODUCTION

This study evaluated the effect of music intervention on the anxiety and stress responses of patients who underwent an interventional cardiac catheterisation.

METHODS

The study design was a pre- and post-test randomised controlled trial that included 94 patients who underwent a transcatheter atrial septal defect closure. Patients were allocated to receive either music intervention (n = 47) or usual care (n = 47) during the interventional cardiac catheterisation. Music intervention effectiveness was examined in terms of anxiety, salivary cortisol level, and heart rate variability.

RESULTS

The average age of participants was 45.40 years (±16.04) in the experimental group and 47.26 years (±13.83) in the control group. Two-thirds (66.0%) of the participants in each group were women. State anxiety (F = 31.42, p < 0.001), anxiety-numerical rating scale (F = 20.08, p < 0.001), salivary cortisol levels (F = 4.98, p = 0.021), and low-frequency component/high-frequency component ratio (F = 17.31, p < 0.001) in the experimental group were significantly reduced compared with those in the control group at the end of the music intervention.

CONCLUSION

This study provides practical evidence of a reduction in anxiety and stress response from music intervention preceding an interventional cardiac catheterisation, indicating that this intervention should be considered in clinical management.

Brief Report: Above and Beyond Safety: Psychosocial and Biobehavioral Impact of Autism-Assistance Dogs on Autistic Children and their Families

Autism-Assistance Dogs (AADs) are highly-skilled service animals trained primarily to ensure the safety of an autistic child by preventing elopement and mitigating 'meltdowns'. Although anecdotal accounts and case-studies have indicated that AADs confer benefits above and beyond safety, empirical support anchored in validated clinical, behavioral, and physiological measures is lacking. To address this gap, we studied children and their families before and after receiving a well-trained AAD using a within-subject, repeated-measures design. Notably, this study is the first to assess change in a biomarker for chronic stress in both autistic children and their parents. Final analyses included pre-/post-AAD data from 11 triads (parent/handler-dog-child) demonstrating significantly positive psychosocial and biobehavioral effects of AADs.

Confounding effects of liquorice, hydrocortisone, and blood contamination on salivary cortisol but not cortisone

Objective

To determine the effects of liquorice consumption, topical hydrocortisone, and blood contamination on salivary cortisol and cortisone concentrations.

Design and methods

Thirty healthy volunteers were randomized to a low, medium, or high dose of liquorice. Late-night saliva samples were collected using a Salivette® collection device at baseline, during 1 week of daily liquorice consumption, and during 4 weeks' washout. Saliva sampling was also performed before and after the application of topical hydrocortisone on the skin. Furthermore, in a subgroup (n = 16), saliva and venous blood were collected from each individual and mixed to achieve graded blood contamination in saliva. Salivary cortisol and cortisone were analyzed with liquid chromatography-tandem mass spectrometry.

Results

Significant increases in salivary cortisol concentrations were observed during medium- (+49%) and high-dose (+97%) liquorice intake, which returned to baseline 4 days after liquorice withdrawal. Topical hydrocortisone on fingers holding the collection swab increased salivary cortisol concentrations >1000-fold with concomitant pronounced elevation of the cortisol:cortisone ratio. Salivary cortisol increased significantly after contamination with blood ≥0.5%. Visual examination could safely detect these samples. Salivary cortisone concentrations were unaffected by liquorice consumption and blood contamination, and only marginally affected by topical hydrocortisone.

Conclusion

Liquorice, topical hydrocortisone, and blood contamination may all cause elevated salivary cortisol concentrations. Improved sampling instructions and visual examination of the sample may minimize these risks. Salivary cortisone is essentially unaffected by the different preanalytical confounders and may be used as a first-line screening test for Cushing's syndrome.

Sensitive and Robust LC-MS/MS Analysis of Salivary Cortisol in Negative Mode

Cortisol is one of the most important glucocorticoids involved in the regulation of human metabolism and physiological stress. Monitoring of levels of cortisol is of immense clinical benefit. In particular, salivary cortisol levels have been shown to correlate well with diurnal changes in cortisol levels in serum and have been used widely for monitoring of cortisol levels for diagnosis and prognosis purposes. We present a sensitive, fast, and robust quantitative liquid chromatography and tandem mass spectrometry (LC-MS/MS) assay for salivary cortisol in negative mode. This assay employs protein precipitation followed by reversed-phase liquid chromatographic separation, negative-mode electrospray ionization (ESI), and MS/MS detection. This assay has a total run time of 5.8 minutes and a limit of quantification of 0.5 ng/mL with a linear range up to 100 ng/mL. No carryover was observed at 10 μg/mL. This assay also incorporates the routine monitoring of prednisolone, a potential interferent to salivary cortisol.

Within-person patterns of psychobiological stress response correspondence: links to preadolescent internalizing problems and coping behaviors

Though correspondence across the affective experience and physiologic arousal levels of the stress response is thought to support efficacious coping and buffer against internalizing problems, little evidence has demonstrated such correspondence. Using a community sample of preadolescents (N=151, Mage=10.33 years, Minage=8.92, Maxage=12.00, 51.7% male), this person-centered study examined internalizing problem and coping-linked variability in psychobiological stress response correspondence. Preadolescents were exposed to the Trier Social Stress Test and self-reported negative affect (NA) and salivary cortisol (SC) levels were assessed. Multitrajectory modeling revealed four subgroups. Relative to In-Touch (i.e., Moderate NA-Moderate SC; n=65), Unmindful (i.e., Moderate NA-Low SC; n=49) were more likely to present with parent-reported but not self-reported internalizing problems; Vigilant (i.e., High NA-Low SC; n=13) were more likely to present with self- and parent-reported internalizing problems, less likely to use engagement coping, and more likely to use wishful thinking (e.g., "I wish problems would just go away."); Denial (i.e., Low NA-High SC; n=24) self-reported similarly low internalizing problems, but were also more likely to report reliance on denial (e.g., "I pretend problems don't exist."). Findings illustrate meaningful heterogeneity in preadolescent psychobiological correspondence with implications for multimodal assessment and outcome monitoring in coping-based preventative interventions.

Clinical and Technical Aspects in Free Cortisol Measurement

Accurate measurement of cortisol is critical in adrenal insufficiency as it reduces the risk associated with misdiagnosis and supports the optimization of stress dose. Comprehensive assays have been developed to determine the levels of bioactive free cortisol and their clinical and analytical efficacies have been extensively discussed because the level of total cortisol is affected by changes in the structure or circulating levels of corticoid-binding globulin and albumin, which are the main reservoirs of cortisol in the human body. Antibody-based immunoassays are routinely used in clinical laboratories; however, the lack of molecular specificity in cortisol assessment limits their applicability to characterize adrenocortical function. Improved specificity and sensitivity can be achieved by mass spectrometry coupled with chromatographic separation methods, which is a cutting-edge technology to measure individual as well as a panel of steroids in a single analytical run. The purpose of this review is to introduce recent advances in free cortisol measurement from the perspectives of clinical specimens and issues associated with prospective analytical technologies.

A synergistic mindsets intervention protects adolescents from stress

Social-evaluative stressors-experiences in which people feel they could be judged negatively-pose a major threat to adolescent mental health1-3 and can cause young people to disengage from stressful pursuits, resulting in missed opportunities to acquire valuable skills. Here we show that replicable benefits for the stress responses of adolescents can be achieved with a short (around 30-min), scalable 'synergistic mindsets' intervention. This intervention, which is a self-administered online training module, synergistically targets both growth mindsets4 (the idea that intelligence can be developed) and stress-can-be-enhancing mindsets5 (the idea that one's physiological stress response can fuel optimal performance). In six double-blind, randomized, controlled experiments that were conducted with secondary and post-secondary students in the United States, the synergistic mindsets intervention improved stress-related cognitions (study 1, n = 2,717; study 2, n = 755), cardiovascular reactivity (study 3, n = 160; study 4, n = 200), daily cortisol levels (study 5, n = 118 students, n = 1,213 observations), psychological well-being (studies 4 and 5), academic success (study 5) and anxiety symptoms during the 2020 COVID-19 lockdowns (study 6, n = 341). Heterogeneity analyses (studies 3, 5 and 6) and a four-cell experiment (study 4) showed that the benefits of the intervention depended on addressing both mindsets-growth and stress-synergistically. Confidence in these conclusions comes from a conservative, Bayesian machine-learning statistical method for detecting heterogeneous effects6. Thus, our research has identified a treatment for adolescent stress that could, in principle, be scaled nationally at low cost.

Teachers' physiological and self-reported stress, teaching practices and students' learning outcomes in Grade 1

BACKGROUND

Teachers' self-reported stress is related to the quality of teacher-student interactions and students' learning outcomes. However, it is unclear if teachers' physiological stress is related to child-centred teaching practices in the classroom and whether teaching practices mediate the link between teachers' stress and students' learning outcomes.

AIMS

We studied the effect of teachers' physiological stress and self-reported stress on their teaching practices and thereby on students' learning outcomes in math.

SAMPLE

A total of 53 classroom teachers and 866 Grade 1 students participated in the study.

METHODS

Salivary cortisol in the middle of the school day and cortisol slope from morning peak to evening were used as indicators of teachers' physiological stress, in addition to self-reported teaching-related stress. Teaching practices were observed with the ECCOM instrument. Students' math skills controlled for gender and previous skills were used as a measure of learning outcomes. Data were analysed with a two-level SEM.

RESULTS

Teachers' physiological stress did not have an effect on teaching practices or students' math skills. Teachers reporting less stress used relatively more child-centred teaching practices compared with teacher-directed ones. These practices had a marginal effect on classroom-level differences in the gain of students' math skills in Grade 1. There was neither a direct nor indirect effect from teachers' stress on students' math skills. Altogether, our model explained 77% of classroom-level variance in math skills.

CONCLUSIONS

Teachers' self-reported stress has an effect on their teaching practices, which, in turn, have a marginal effect on students' learning outcomes.

Neither Threat of Shock nor Acute Psychosocial Stress Affects Ambiguity Attitudes

Decisions under uncertainty can be differentiated into two classes: risky, which has known probabilistic outcomes, and ambiguous, which has unknown probabilistic outcomes. Across a variety of types of decisions, people find ambiguity extremely aversive, subjectively more aversive than risk. It has been shown that the transient sympathetic arousal response to a choice predicts decisions under ambiguity but not risk, and that lifetime stress uniquely predicts attitudes toward ambiguity. Building on these findings, this study explored whether we could bias ambiguity and risk preferences with an arousal or acute stress manipulation that is incidental to the choice in two independent experiments. One experiment induced sympathetic arousal with an anticipatory threat paradigm, and the other manipulated incidental acute stress via a psychosocial stressor. The efficacy of the manipulations was confirmed via pupil dilation and salivary cortisol, respectively. Participants made choices between a guaranteed $5 option and a lottery with either a known (risky) or unknown (ambiguous) probabilistic outcome. Consistent with previous findings, participants were more averse to a given level of ambiguity than to a numerically equal level of risk. However, in contrast to our hypothesis, we found no evidence that transient arousal or acute stress that is incidental to the choice biases ambiguity preferences.

Early Adversity and Changes in Cortisol and Negative Affect in Response to Interpersonal Threats in the Laboratory

Adverse childhood experiences, such as abuse and neglect, are associated with poor health outcomes. This association may be partially explained by differences in stress physiology. Though most early adverse experiences occur within the context of interpersonal relationships, stress exposures manipulated in the laboratory rarely involve interpersonal interactions beyond the mere presence of others. This study examines whether adverse childhood experiences are associated with differences in affective and cortisol reactivity to two stressors which may more closely resemble the powerlessness and the lack of control characteristic of many adverse childhood experiences: a dominant (vs. submissive) interaction partner and lower (vs. higher) social status. We also manipulate social-evaluative threat as a test of whether these interpersonal stressors are more germane to stress reactivity associated with early adversity than the performance anxiety evoked by more traditional laboratory stressors, such as the Trier Social Stress Test. The results partially support the hypothesis that participants with greater early adversity may be more reactive to interpersonal stressors reminiscent of early adverse experience. Given the interpersonal nature of most adverse childhood experiences, conceptualizing and measuring associations with stress physiology in an interpersonal context may more closely capture the psychological and biological embedding of these early experiences.

Chemiluminescent immunoassay overestimates hormone concentrations and obscures testosterone sex differences relative to LC-MS/MS in a field study of diverse adolescents

Background

Methodological comparisons of hormone quantification techniques have repeatedly demonstrated that, in adults, enzyme immunoassay (EIA) inflates steroid hormone concentrations relative to mass spectrometry. However, methodological comparisons in adolescent samples remain rare, and few studies have examined how chemiluminescent immunoassay (CLIA), another popular immunoassay, compares to mass spectrometry. Additionally, no studies have examined how differences in analytical techniques may be affecting relationships between steroid hormone levels and outcomes of interest, such as psychopathology. This pre-registered analysis of an existing dataset measured salivary cortisol and testosterone using both CLIA and liquid chromatography dual mass spectrometry (LC-MS/MS) in a repeated measures (516 samples) sample of 207 9th graders.

Methods

In aim 1, this study sought to expand on past findings by 1) measuring inflation of testosterone and cortisol by CLIA in a relatively large adolescent sample, and 2) showing that CLIA (like EIA) testosterone inflation was especially true in groups with low ‘true’ testosterone levels. In aim 2, this study sought to examine the impact of hormone quantification method on relationships between hormone levels and psychopathological measures (the Children's Depression Inventory, the Perceived Social Stress Scale, the UCLA Loneliness Scale, and the Anxious Avoidant and Negative Self Evaluation subscales of the Social Anxiety Scale for Adolescents).

Results

We found that CLIA, like EIA, inflated testosterone and cortisol levels and overestimated female testosterone resulting in suppressed sex differences in testosterone. We did not observe these same patterns when examining testosterone in individuals with differing levels of pubertal development. Results of psychopathology analyses demonstrated no significant method differences in hormone-psychopathology relationships.

Conclusions

Our findings show that CLIA introduces proportional bias in cortisol and testosterone in a manner that suppresses sex differences in testosterone. Steroid measurement method did not significantly moderate the relationship between hormones and psychopathology in our sample, though more work is needed to investigate this question in larger, clinical samples.

•

Pre-registered comparison of 516 samples of CLIA and LC/MS-MS-assessed cortisol and testosterone from 207 adolescents.

•

CLIA overestimated cortisol and testosterone relative to LC-MS/MS and suppressed sex differences in testosterone.

•

No significant moderating effect of method on hormone-psychopathology relationships.

•

LC-MS/MS should be used to measure steroid hormones when possible.

•

Further research is needed to examine how method differences may be impacting hormone-psychopathology findings.

Rapidity and Precision of Steroid Hormone Measurement

Steroids are present in all animals and plants, from mammals to prokaryotes. In the medical field, steroids are commonly classified as glucocorticoids, mineralocorticoids, and gonadal steroid hormones. Monitoring of hormones is useful in clinical and research fields for the assessment of physiological changes associated with aging, disease risk, and the diagnostic and therapeutic effects of various diseases. Since the discovery and isolation of steroid hormones, measurement methods for steroid hormones in biological samples have advanced substantially. Although immunoassays (IAs) are widely used in daily practice, mass spectrometry (MS)-based methods have been reported to be more specific. Steroid hormone measurement based on MS is desirable in clinical practice; however, there are several drawbacks, including the purchase and maintenance costs of the MS instrument and the need for specialized training of technicians. In this review, we discuss IA- and MS-based methods currently in use and briefly present the history of steroid hormone measurement. In addition, we describe recent advances in IA- and MS-based methods and future applications and considerations.

The effect of oral contraceptive use on cortisol reactivity to the Trier Social Stress Test: A meta-analysis

BACKGROUND

Some research suggests that oral contraceptive pills (OCPs) blunt the cortisol stress response, thus OCP users are often excluded from stress research. The current study examined changes in salivary cortisol among females taking OCPs and naturally cycling (NC) females after exposure to the Trier Social Stress Test (TSST).

METHODS

The literature search included the terms "oral contraceptives" OR "oral contraception" OR "birth control" OR "birth control pill" AND "Trier Social Stress Test" OR "TSST" AND "cortisol" OR "salivary cortisol." A total of 14 studies with 36 independent samples were included in the meta-analysis. Participant information, including pre- and post- TSST measures of salivary cortisol, and subgroup (i.e., OCP or menstrual cycle phase), were extracted. Additional study characteristics including age, length of stressor, type of OCP, time of day the cortisol samples were collected, and type of cortisol assay used were also considered.

RESULTS

Findings from the current meta-analysis indicated that changes in salivary cortisol in NC participants following the TSST, D = 4.31, SE = 0.53, 95% CI = 3.27, 5.35, were greater than the changes observed in participants on OCPs D = 1.50, SE = 0.30, 95% CI = 0.91, 2.09. Study effects were heterogeneous, Fisher's Z = 10.87, Q = 620.57, p = < 0.001. Between-phase analyses were also conducted.

CONCLUSIONS

Results demonstrate that OCPs blunt cortisol reactivity relative to NC females. There was significant heterogeneity, except between OCP and follicular phase groups. Implications for research design and methodology are discussed.

Wearable aptamer-field-effect transistor sensing system for noninvasive cortisol monitoring

Wearable technologies for personalized monitoring require sensors that track biomarkers often present at low levels. Cortisol—a key stress biomarker—is present in sweat at low nanomolar concentrations. Previous wearable sensing systems are limited to analytes in the micromolar-millimolar ranges. To overcome this and other limitations, we developed a flexible field-effect transistor (FET) biosensor array that exploits a previously unreported cortisol aptamer coupled to nanometer-thin-film In₂O₃ FETs. Cortisol levels were determined via molecular recognition by aptamers where binding was transduced to electrical signals on FETs. The physiological relevance of cortisol as a stress biomarker was demonstrated by tracking salivary cortisol levels in participants in a Trier Social Stress Test and establishing correlations between cortisol in diurnal saliva and sweat samples. These correlations motivated the development and on-body validation of an aptamer-FET array–based smartwatch equipped with a custom, multichannel, self-referencing, and autonomous source measurement unit enabling seamless, real-time cortisol sweat sensing.

An Evaluation of Speech-Based Recognition of Emotional and Physiological Markers of Stress

Life in modern societies is fast-paced and full of stress-inducing demands. The development of stress monitoring methods is a growing area of research due to the personal and economic advantages that timely detection provides. Studies have shown that speech-based features can be utilised to robustly predict several physiological markers of stress, including emotional state, continuous heart rate, and the stress hormone, cortisol. In this contribution, we extend previous works by the authors, utilising three German language corpora including more than 100 subjects undergoing a Trier Social Stress Test protocol. We present cross-corpus and transfer learning results which explore the efficacy of the speech signal to predict three physiological markers of stress—sequentially measured saliva-based cortisol, continuous heart rate as beats per minute (BPM), and continuous respiration. For this, we extract several features from audio as well as video and apply various machine learning architectures, including a temporal context-based Long Short-Term Memory Recurrent Neural Network (LSTM-RNN). For the task of predicting cortisol levels from speech, deep learning improves on results obtained by conventional support vector regression—yielding a Spearman correlation coefficient (ρ) of 0.770 and 0.698 for cortisol measurements taken 10 and 20 min after the stress period for the two corpora applicable—showing that audio features alone are sufficient for predicting cortisol, with audiovisual fusion to an extent improving such results. We also obtain a Root Mean Square Error (RMSE) of 38 and 22 BPM for continuous heart rate prediction on the two corpora where this information is available, and a normalised RMSE (NRMSE) of 0.120 for respiration prediction (−10: 10). Both of these continuous physiological signals show to be highly effective markers of stress (based on cortisol grouping analysis), both when available as ground truth and when predicted using speech. This contribution opens up new avenues for future exploration of these signals as proxies for stress in naturalistic settings.

Reading Skills, Social Competence, and Physiological Stress in the First Grade

An awareness of school-related antecedents of children’s physiological stress at the beginning of school helps educators to prevent and mitigate children’s stress, the one of the major obstacles to their well-being and academic progress. We aimed to study the effect of reading skills and social competence on first-grade students’ salivary cortisol levels in natural settings. Based on previous results of the effects of everyday situations on children’s stress according to gender, we expected that both academic and social skills would affect girls’ physiological stress more, compared to boys. Our sample consisted of 277 students (7–8 years old, 50.2% girls). We used the highest salivary cortisol level of three morning samples and a cortisol level from the middle of the school day as physiological stress indicators. Reading skills were assessed by group-administered tests and social competence by teacher ratings. We found that lower reading comprehension skills and lower disruptiveness were related to higher cortisol levels for girls but not for boys. Higher empathy and lower disruptiveness moderated the effect of better reading comprehension on higher psychological stress in the middle of the school day only for girls. By recognizing the antecedents of children’s stress and supporting their academic and social skills, children’s, especially girls’, physiological self-regulation and coping skills in the primary grades will benefit.

Positive and negative affect are associated with salivary cortisol in the everyday life of older adults: A quantitative synthesis of four aging studies

Research on time-fluctuating links between positive affect and cortisol is inconsistent and mostly based on young to middle-aged samples. The current project investigated how moment-to-moment changes in positive and negative affect are associated with moment-to-moment changes in cortisol levels in older adults' daily lives and whether those associations are moderated by differences in health status (as indicated by the number of comorbidities). Affect and cortisol data collected in four separately conducted momentary assessment studies with parallel protocols were pooled to obtain a sample of N=476 individuals aged 56-88 years (M_age=71.9, SD=6.6; 52% female). Participants provided affect reports and collected salivary cortisol 5-7 times a day for a 7-day period and reported the presence of 13 different health conditions. Data were analyzed using multilevel models, with time since waking, daily behaviors associated with cortisol secretion, age, and sex controlled. Feeling more positive affect than usual was associated with lower momentary cortisol. In contrast, feeling more negative affect than usual was associated with higher momentary cortisol. Associations of momentary positive and negative affect with cortisol were weaker among participants in worse as compared to those in better health. Trait positive affectivity was associated with more curvature of waking cortisol profiles and trait negative affectivity was associated with smaller cortisol awakening responses. Findings suggest that HPA axis responses fluctuate with everyday changes in positive and negative affect in older adults, and that higher HPA reactivity may indicate preserved health in this age group.

Effects of psychological, sensory, and metabolic energy prime manipulation on the acute endocrine stress response in fasted women

The stress response supports survival through energy mobilization. Paradoxically, a low blood glucose level dampens the endocrine stress response, and sugar consumption prior to stress restores it. Thus, energy availability may play a causal role in the endocrine stress response. Yet, it has never been tested whether sweet taste or expectations towards a drink content modulate the stress response. We investigated the potential role of sweetness, energy load and expectations towards energy load of a drink consumed prior to stress in restoring stress reactivity after fasting. N = 152 women (meanage=21.53, sdage=2.61) participated in the Trier Social Stress Test for groups in the morning after an overnight fast. Prior to stress induction, participants consumed a drink containing saccharose (sugar, n = 51), an equally sweet drink containing non-caloric sweetener (sweetener, n = 46), or water (n = 56). Additionally, participants in the sugar and sweetener group (n = 97) were informed whether or not their drink contained any calories (energy prime), which was deceptive in 50% of the cases. Eight salivary cortisol (-30, -20, -10, 0, +12, +25, +35, +45 min) and three blood glucose samples (-30, 0, +25 min) were assessed throughout the experiment. The effects of the experimental manipulations on cortisol trajectories were tested using multilevel mixed models. We found that compared with water, sugar and sweetener both significantly increased cortisol stress reactivity and with comparable intensity. However, our sensitivity analysis revealed a significant effect of sugar on cortisol trajectories compared to water and to sweetener. Drink-induced changes in blood glucose concentration were not associated with increases in cortisol. The energy prime did not affect the stress response. Overall, we could replicate the boosting effect of sugar consumption in a female sample after 8 h of fasting. The specific contribution of sweet taste and metabolic hormones to this boosting effect should be tested more rigorously in sex-balanced designs in the future.

UPLC-TOF-MS Method for Simultaneous Quantification of Steroid Hormones in Tissue Homogenates of Zebrafish with Solid-Phase Extraction

The quantification of steroid hormones of individual zebrafish (Danio rerio) provides perspective to understand endogenous hormone function. A UPLC–TOF–MS method was developed to provide a reproducible, sensitive, and efficient assay to determine the concentration of steroid hormones, including cortisol, testosterone, androstenedione, 11-deoxycortisol, 11-deoxycorticosterone, and 17-hydroxyprogesterone in whole-body homogenates of each zebrafish. Solid-phase extraction was used to sample matrix clean-up and acquired a recovery from 89.7% to 107.9%. The analytes were separated on an Aquity BEH C18 column using gradient elution. Mass spectrometric analysis was performed by single reaction monitoring (SRM) using positive electrospray ionization mode. The total running time was 6 min, which was greatly shortened compared with a previously reported method. The developed method exhibited excellent linearity for all the analytes, with regression coefficients higher than 0.99. The limit of detection varied between 0.1 and 0.5 ng/L and the limit of quantification was 0.5–1.7 ng/L for all analytes. The precision of the method was assessed on replicate measurements and was found to be in the ranges of 1.9 % to 6.6% and 4.3% to 8.6%, for intra- and inter-day analysis, respectively. This method was validated according to FDA guidance and applied to determine steroid hormone levels in the tissue homogenate of zebrafish acutely treated with caffeine and ethanol.

Analysis of hair steroid hormones in polar bears (Ursus maritimus) via liquid chromatography-tandem mass spectrometry: comparison with two immunoassays and application for longitudinal monitoring in zoos

Analysis of hair cortisol concentrations (HCCs) is a promising method for monitoring long-term stress in mammals. However, previous measurements of HCCs in polar bears (Ursus maritimus) have yielded highly variable results, which are likely due to different methodological approaches. In this study, hair samples of zoo-housed polar bears were analyzed for cortisol with two independent immunoassays [an enzyme-linked immunoassay (EIA) and a chemiluminescence assay (CLIA)] and liquid chromatography-tandem mass spectrometry (LC-MS/MS). HCC measurements depended significantly on assay type applied, sample processing (cutting vs. powdering hair) and their interaction. Best agreement was observed between LC-MS/MS and CLIA (R² = 0.81 for powdered hair) and sample processing had a minor, albeit significant, effect on obtained HCC measurements in these assays (R² > 0.9). EIA measurements were consistently higher than with the other assays. HCC measurement was validated biologically for CLIA and LC-MS/MS in one male polar bear that experienced considerable stress for a prolonged period of time (> 18 weeks). Subsequently, by using the validated LC-MS/MS the measurement of cortisol could be complemented by the analysis of other steroids including cortisone, testosterone and progesterone levels from hair samples collected over a 9-month period (5-13 months) from six zoo-housed polar bears (five males, one female). No seasonal steroid variation was observed except in male progesterone levels. For all steroids except cortisone, a strong body region effect (neck or paw) was observed. Cortisol and cortisone, as well as progesterone and testosterone, concentrations were positively correlated. We show that hair steroid concentrations can be used to longitudinally measure stress and reproductive hormone axes in polar bears. The data established herein provide important basic information regarding methodology and study design for assessing hair steroid hormones.

Quantifying the subjective cost of self-control in humans

Since Odysseus committed to resisting the Sirens, mechanisms to limit self-control failure have been a central feature of human behavior. Psychologists have long argued that the use of self-control is an effortful process and, more recently, that its failure arises when the cognitive costs of self-control outweigh its perceived benefits. In a similar way, economists have argued that sophisticated choosers can adopt "precommitment strategies" that tie the hands of their future selves in order to reduce these costs. Yet, we still lack an empirical tool to quantify and demonstrate the cost of self-control. Here, we develop and validate an economic decision-making task to quantify the subjective cost of self-control by determining the monetary cost a person is willing to incur in order to eliminate the need for self-control. We find that humans will pay to avoid having to exert self-control in a way that scales with increasing levels of temptation and that these costs appear to be modulated both by motivational incentives and stress exposure. Our psychophysical approach allows us to index moment-to-moment self-control costs at the within-subject level, validating important theoretical work across multiple disciplines and opening avenues of self-control research in healthy and clinical populations.

A meta-analysis of blood and salivary cortisol levels in first-episode psychosis and high-risk individuals

Dysregulated cortisol responses and glucose metabolism have been reported in psychosis. We performed a random-effects meta-analysis of cortisol responses in first-episode psychosis (FEP) and psychosis risk states, taking into consideration glucose metabolism. A total of 47 studies were included. Unstimulated blood cortisol levels were significantly higher (g = 0.48, 95 %CI: 0.25-0.70, p < 0.001) in FEP, but not in psychosis risk states (g = 0.39, 95 %CI: -0.42-1.21, p = 0.342), compared to controls. Cortisol awakening response (CAR) was attenuated in FEP (g = -0.40, 95 %CI: -0.68 - -0.12, p = 0.006), but not in psychosis risk states (p = 0.433). Glucose and insulin levels were positively correlated with unstimulated blood cortisol levels in FEP. Our meta-analysis supports previous findings of elevated blood cortisol levels and attenuated CAR in FEP. Future research should focus on identifying the common denominators for alterations in stress hormones and glucose metabolism.

A Synergistic Mindsets Intervention Protects Adolescents from Social Stress

Social stress poses a major threat to adolescent health via its effects on internalizing symptoms, such as anxiety and depression. Available interventions to help adolescents improve their stress responses, however, have not been effective in rigorous evaluation studies, or they have been difficult to administer widely. Here we show that replicable improvements in adolescent stress responses can be achieved with a short (~30-minute), scalable synergistic mindsets intervention. This intervention, which is a self-administered online training module, targets both growth mindsets (the idea that people's intelligence can be developed in response to challenge) and stress-can-be-enhancing mindsets (the idea that people's stress responses can be fuel for optimal performance). Its goal is to promote positive engagement with stressful events (e.g., learning from failure on a quiz or a conflict with a peer) and to encourage adolescents to use their responses to stressful events and even their bodily symptoms (e.g. racing heart, sweaty palms, butterflies in their stomach) to their advantage. In five double-blind, randomized, controlled trials (total N = 4,091 adolescents), the new synergistic mindsets intervention improved stress-related cognitions (Studies 1-2), cardiovascular reactivity (Study 3), daily internalizing symptoms and cortisol levels (Study 4), and generalized anxiety symptoms during the 2020 COVID-19 lockdowns (Study 5). Effects on downstream outcomes (in Studies 3-5) were stronger among individuals who, at baseline, held the two negative mindsets targeted by the intervention, providing evidence for the proposed mechanisms. Confidence in this conclusion comes from a conservative, Bayesian machine-learning method for detecting heterogeneity.

Deciphering the Association Between Hypothalamus-Pituitary-Adrenal Axis Activity and Obesity: A Meta-Analysis

OBJECTIVE

Both the cortisol awakening response (CAR; corresponding to the state measurement) and hair cortisol concentration (HCC; corresponding to the trait measurement) are considered reliable markers of hypothalamus-pituitary-adrenal axis activity. Because cortisol has long been associated with adiposity, this systematic review and meta-analysis aims to summarize and compare the literature around CAR and HCC and their association with obesity or fat distribution indices.

METHODS

The PubMed, Web of Science (Web of Science Core Collection and Medline), EBSCO Information Services, Embase, and PsycNET databases were searched, and full-text articles investigating the association between CAR or HCC and markers of adiposity in humans were included. Meta-analyses were then performed to compare studies associating CAR or HCC with BMI (a marker of general adiposity) and waist circumference (a marker of fat distribution).

RESULTS

The results of this review highlight inconsistencies in cortisol sampling and CAR computation, which makes comparisons between studies difficult. It was found that adiposity indices are not associated with CAR but that they correlate significantly and positively with HCC. The subgroup analysis hinted to possible age differences in the magnitude of the association between HCC and BMI.

CONCLUSIONS

Trait rather than state measurement of the hypothalamus-pituitary-adrenal axis activity is associated with increased general and abdominal adiposity in humans.

Noninvasive detection of human dehydroepiandrosterone, progesterone and testosterone using LC-MS/MS revealed effects of birth control pills/devices and body weight on ovulatory prediction

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been increasingly used to measure steroids in human saliva. We studied the performance of a conventional LC-MS/MS for measuring dehydroepiandrosterone (DHEA), testosterone and progesterone in human saliva. These three steroids were co-extracted by liquid-liquid extraction and derivatized. Derivatives were resolved on a C18 column and quantified using an LC-MS/MS (AB Sciex API 2000) instrument. The assay's limits of quantification were 0.03 ng/mL for all three steroids. Inter-assay coefficients of variation were 16.6-18.8% (DHEA), 12.0-15.8% (testosterone), and 12.7-19.3% (progesterone). Assay linearity analysis showed R² of 0.9926, 0.9750 and 0.9949 for DHEA, testosterone and progesterone, respectively. No carry-over between samplings was observed. An ion-enhancement effect of 11.6% for DHEA determination and ion-suppression effects of 13.9% and 20.7% for analysis of progesterone and testosterone, respectively, were determined. No interferences by 9 steroid analogs were detected. Spiked recoveries were 85.5% (DHEA), 86.5% (testosterone), and 92.6% (progesterone). Comparison with laboratory developed test (LDT)-LC-MS/MS methods by other New York State Department of Health certified laboratories revealed R² = 0.9425 (DHEA, LC-MS/MS = 1.0267 LDT + 21.989), R² = 0.9849 (testosterone, LC-MS/MS = 0.9447 LDT + 9.8037), and R² = 0.9736 (progesterone, LC-MS/MS = 1.1196 LDT + 0.0985). Reference intervals for the 3 steroids in saliva for young males and females were estimated. Results of intra-individual salivary progesterone analysis indicated that caution should be exercised when using progesterone concentrations in predicting ovulation for females who are under treatment with birth control pills/devices or has body a weight of > 90 kg.

Combined Chair-Based Exercises Improve Functional Fitness, Mental Well-Being, Salivary Steroid Balance, and Anti-microbial Activity in Pre-frail Older Women

Introduction

Regular exercise has long been shown to positively impact the immune system responsiveness and improve mental well-being (MWB). However, the putative links between biomarkers of mental health and immune efficiency in exercising subjects have been scarcely investigated. The aim of this study was to verify the effect of a 14-week combined chair-based exercise program (CEP) on salivary steroid hormones and anti-microbial proteins, functional fitness, and MWB indexes in pre-frail older women.

Methods

The participant women (82.8 4.6 years old; n = 32) were randomly divided into the exercising group (CEP, n = 17) and the non-exercising control group (CG, n = 15). The pre/post assessment included: (1) salivary anti-microbial proteins lysozyme; (Lys) and immunoglobulin-A (IgA); (2) salivary steroid hormones of testosterone (TT) and cortisol (COR); (3) functional fitness (gait speed, hand grip strength, and static balance); (4) MWB questionnaires (happiness, depression state, satisfaction with life, and stress).

Results

Significant differences with large Cohen's (d) effect sizes were found on increased salivary TT (p < 0.05; d = 0.60) after exercise intervention. The results revealed a decrease in IgA levels after CEP (p < 0.01, d = 0.30). The increase in subjective happiness levels (p < 0.05, d = 0.30) and decrease of stress perception (p < 0.01, d = 2.60) and depressive state (p < 0.05, d = 0.30) were found after intervention in the CEP group. Robust statistical differences in gait speed (p < 0.05; d = 0.60) and balance tests (p < 0.05; d = 0.80) were also found in the CEP group. In control, COR increased moderately (p < 0.05; d = 0.65) while no changes were found for the other indicators. Correlation analyses showed inter-dependence between pre-post variations of MWB, biochemical indexes, and fitness function (e.g., COR inverse correlation with hand grip strength and balance tests).

Conclusion

The CEP program was able to improve functional-fitness performance, decrease feelings of stress, and increase happiness. The CEP also induced clinically relevant hormonal and immune responses, which suggests that chair exercises that combine muscular strength, balance, and gait speed training are promising interventions to improve physical and mental health of older pre-frail adults.

Increased methylation of NR3C1 and SLC6A4 is associated with blunted cortisol reactivity to stress in major depression

Background

Epigenetic changes are considered the main mechanisms behind the interplay of environment and genetic susceptibility in major depressive disorder (MDD). However, studies focusing on epigenetic dysregulation of the HPA axis stress response in MDD are lacking. Our objective was to simultaneously asses DNA methylation of the glucocorticoid receptor gene (NR3C1) and serotonin transporter gene (SLC6A4) and HPA axis response to stress in MDD.

Methods

We recruited 80 depressed inpatients and 58 gender and age matched healthy controls. All participants underwent the Trier Social Stress Test (TSST) and salivary cortisol was repeatedly measured to assess HPA axis reactivity. DNA methylation of the NR3C1 (exon 1 F) and SLC6A4 CpG islands was quantified from whole blood DNA. In the MDD group, clinical assessment was repeated at 8-week follow-up to test the predictive potential of DNA methylation for symptom improvement.

Results

Depressed patients had blunted cortisol reactivity to TSST compared to healthy controls (p = 0.01). In addition, they presented with increased average SLC6A4 (p = 0.003) and NR3C1 methylation (p = 0.03), as well as methylation of two individual NR3C1 CpG loci overlapping with the NGFI-A-binding sites (CpG12 and CpG20). Methylation of one of these two loci (CpG20) predicted lower symptom improvement at the follow-up (p = 0.007). Both, average NR3C1 and SLC6A4 methylation were associated with lower cortisol reactivity in the MDD group and explained about 16% of variability in cortisol response to TSST.

Conclusions

We provide evidence of the role of NR3C1 and SLC6A4 DNA methylation in HPA axis dysregulation in MDD, which needs to be further explored.

Salivary cortisol levels during Ramadan fasting in hydrocortisone-treated secondary adrenal insufficiency patients

OBJECTIVE

Patients with adrenal insufficiency have difficulties in fasting during the month of Ramadan with an increased risk of complications. Cortisol levels are unknown in these patients. The objective of this study was to assess the daily cortisol profile in hydrocortisone-treated patients with secondary adrenal insufficiency (SAI) and healthy controls during a fasting day.

METHODS

A cross-sectional matched case-control study on 50 hydrocortisone-treated SAI patients and 69 controls who are used to fast. Clinical and therapeutic data were collected. Five salivary samples for cortisol measurement were collected throughout a fasting day of the third week of Ramadan 2019.

RESULTS

Salivary cortisol levels were significantly higher on awakening, at midnight and before the predawn meal in patients compared with controls. The circadian cortisol rhythm was disrupted in patients. The area under the salivary cortisol level versus time curve (AUC) was lower than the 2.5th percentile of the controls in one patient (2.5%) and higher than the 97.5th percentile in 23 patients (59%) who were considered overtreated. Age ≥ 35 years was independently associated with overtreatment (adjusted odds ratio = 12.0; 95% CI (2.0-70.4); p = 0.006). Seven patients broke their fasting for a complication compared with no one of the controls (p = 0.001). No factor was associated with this risk.

CONCLUSIONS

Salivary cortisol levels were high in fasting hydrocortisone-treated SAI patients with a disruption of the circadian rhythm.

Current methods for stress marker detection in saliva

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Introduction of relevant biomarkers in stress conditions.

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Reference ranges of biomarkers in normal conditions.

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Saliva as easy-accessible specimen.

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Review of analytical methods for biomarker determination in saliva.

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Possibilities for design of point-of-care devices.

Stress and stress-related diseases are leading to drastic consequences in private and professional life. Therefore, the need for stress prevention strategies is of personal and economic interest. Especially during the recent period related to covid-19 outbreak and lock-down, an ongoing discussion of increasing stress etiology is reported. Biomarker analysis may help to assist diagnosis and classification of stress-related diseases and therefore support therapeutical decisions. Due to its non-invasive sampling, the analysis of saliva has become highly attractive compared to the detection methods in other specimen. This review article summarizes the status of research, innovative approaches, and trends. Scientific literature published since 2011 was excerpted with concentration on the detection of up to seven promising marker substances. Most often reported cortisol represents the currently best evaluated stress marker, while norepinephrine (noradrenaline) or its metabolite 3-methoxy-4-hydroxyphenylglycol is also a quite commonly considered stress marker. Other complementary stress marker candidates are testosterone, dehydroepiandrosterone (DHEA) and its sulfonated analogue DHEA-S, alpha-amylase, secretory immunoglobulin A, and chromogranin A. Several working groups are researching in the field of stress marker detection to develop reliable, fast, and affordable methods. Analytical methods reported mainly focused on immunological and electrochemical as well as chromatographic methods hyphenated to mass spectrometric detection to yield the required detection limits.

Hormonal and modality specific effects on males' emotion recognition ability

Successful emotion recognition is a key component of human socio-emotional communication skills. However, little is known about the factors impacting males' accuracy in emotion recognition tasks. This pre-registered study examined potential candidates, focusing on the modality of stimulus presentation, emotion category and individual baseline hormone levels. In an additional exploratory analysis, we examined the association of testosterone x cortisol interaction with recognition accuracy and reaction times. We obtained accuracy and reaction time scores from 282 males who categorized voice, face and voice-face stimuli for nonverbal emotional content. Results showed that recognition accuracy was significantly higher in the audio-visual than in the auditory or visual modality. While Spearman's rank correlations showed no significant association of testosterone (T) with recognition accuracy or with response times for specific emotions, the logistic and linear regression models uncovered some evidence for a positive association between T and recognition accuracy as well as between cortisol (C) and reaction time. In addition, the overall effect size of T by C interaction with recognition accuracy and reaction time was significant, but small. Our results establish that audio-visual congruent stimuli enhance recognition accuracy and provide novel empirical support by showing that the interaction of testosterone and cortisol relates to males' accuracy and response times in emotion recognition tasks.

Late-Night Salivary Cortisol in Healthy, Community-Dwelling Asian Indians Assessed by Second-Generation ECLIA

BACKGROUND

Late-night salivary cortisol (LNSC) is used as a screening test for Cushing syndrome (CS), but there is no community-derived normative data for the normal upper limit in the South Asian population. This study aimed to determine the upper limit of normal (97.5th percentile) for LNSC in an Asian Indian population using a commercially available second-generation electrochemiluminiscence immunoassay (ECLIA).

METHODS

LNSC in apparently healthy community-dwelling individuals was assessed by multistage cluster sampling. Healthy individuals age 18 to 60 years from 8 urban and 8 rural clusters of Thiruvananthapuram district were studied. Thirty people from an approximate population of 1000 individuals from each cluster participated in the study. A saliva sample was collected between 11 PM and 12 midnight and analyzed using Roche COBAS-e-411 and ultrasensitive Cortisol II kits the next day.

RESULTS

Cortisol values from 474 salivary samples were available for final analysis after exclusion of improperly collected samples. The 97.5th percentile of the LNSC concentrations was 0.25 μg/dL (6.89 nmol/L) (90% CI, 0.23-0.27 μg/dL; ie, 6.34-7.45 nmol/L). In postmenopausal women, median LNSC was significantly higher but the 90% CI for the upper limit of their LNSC (0.28μg/dL or 7.72 nmol/L) overlapped with that of premenopausal women.

CONCLUSIONS

This study establishes the normal value of LNSC estimated by second-generation ECLIA in healthy community-dwelling Asian Indian individuals for the first time. Salivary cortisol at 11 pm to 12 am is less than 0.25μg/dL (6.89 nmol/L) in the general Asian Indian population. Menopause causes a significant increase in LNSC and may lead to overdiagnosis of CS if not interpreted carefully.

Prospective Evaluation of Late-Night Salivary Cortisol and Cortisone by EIA and LC-MS/MS in Suspected Cushing Syndrome

Context

Late-night salivary cortisol (LNSC) measured by enzyme immunoassay (EIA-F) is a first-line screening test for Cushing syndrome (CS) with a reported sensitivity and specificity of >90%. However, liquid chromatography-tandem mass spectrometry, validated to measure salivary cortisol (LCMS-F) and cortisone (LCMS-E), has been proposed to be superior diagnostically.

Objective, Setting, and Main Outcome Measures

Prospectively evaluate the diagnostic performance of EIA-F, LCMS-F, and LCMS-E in 1453 consecutive late-night saliva samples from 705 patients with suspected CS.

Design

Patients grouped by the presence or absence of at least one elevated salivary steroid result and then subdivided by diagnosis.

Results

We identified 283 patients with at least one elevated salivary result; 45 had an established diagnosis of neoplastic hypercortisolism (CS) for which EIA-F had a very high sensitivity (97.5%). LCMS-F and LCMS-E had lower sensitivity but higher specificity than EIA-F. EIA-F had poor sensitivity (31.3%) for adrenocorticotropic hormone (ACTH)-independent CS (5 patients with at least 1 and 11 without any elevated salivary result). In patients with Cushing disease (CD), most nonelevated LCMS-F results were in patients with persistent/recurrent CD; their EIA-F levels were lower than in patients with newly diagnosed CD.

Conclusions

Since the majority of patients with ≥1 elevated late-night salivary cortisol or cortisone result did not have CS, a single elevated level has poor specificity and positive predictive value. LNSC measured by EIA is a sensitive test for ACTH-dependent Cushing syndrome but not for ACTH-independent CS. We suggest that neither LCMS-F nor LCMS-E improves the sensitivity of late-night EIA-F for CS.

Salivary cortisol measurement in horses: immunoassay or LC-MS/MS?

The aim of the present study was to measure salivary cortisol concentrations of horses before and after hypothalamic-pituitary-adrenal (HPA) axis stimulation by means of liquid chromatography-tandem-mass spectrometry (LC-MS/MS) and an immunoassay (cELISA) for method comparison. Nine clinically healthy horses participated in the study. An ACTH stimulation test was performed. Saliva samples were collected before (T0) and 60 (T60) min after intravenous injection of 1 μg/kg BW synthetic ACTH1-24. LC-MS/MS was assessed for the determination of equine salivary cortisol. The results of these measurements were then compared to the results obtained by a cELISA, which has previously been validated for use in horses. The Pearson correlation coefficient was calculated and showed no correlation at T0 (r = -0.2452; P = 0.5249) and significantly correlated results at T60 (r = 0.8334; P = 0.0053). Bland-Altman-Plots of T60 revealed that immunoassay measurements led to higher outcome values than LC-MS/MS. On average, immunoassay results were 2.3 times higher. Poor agreement between both methods at T0 is potentially a consequence of inaccuracy in the very low measuring range of the immunoassay, and to a smaller extent, structurally similar cross-reacting agents and matrix effects, which might bias the results. Overestimation of immunoassay results at T60 might be due to different standardization of both methods, non-avoidable matrix effects on the antigen-antibody interaction in the ELISA, and possibly cross-reactions of other steroids. While immunoassay measurements of equine salivary cortisol yielded higher but reasonably correlated results for elevated cortisol concentrations after stimulation of the HPA axis, LC-MS/MS provided more accurate results, particularly for baseline cortisol concentrations close to the limit of detection of the ELISA.

Imagining a positive future reduces cortisol response to awakening and reactivity to acute stress

The positive influence of optimism on health is thought to be due in part to a reduced physiological response to stress, as manifested for instance in activity of hypothalamic-pituitary-adrenal (HPA) systems. Results of previous studies support the notion that dispositional optimism can influence diurnal cortisol secretion as well as cortisol reactivity. The aim of the present study was to examine whether induced optimism can similarly affect HPA activity and thereby potentially have beneficial health effects. We assigned 66 university students to either the Best Possible Self (BPS) or an active control condition, respectively entailing two weeks of daily visualization of a positive future or time management exercises. Before and after the intervention, we assessed diurnal cortisol levels, response to awakening (CAR), and reactivity to the Trier Social Stress Task (TSST), as well as optimism, affect, negative cognitions, perceived stress, and threat appraisal. Effects of the BPS intervention were tested with repeated measures ANOVA (psychological outcomes) and multilevel regression (cortisol outcomes). The BPS intervention was associated with decreases in both the CAR and cortisol responses to acute stress. Compared to controls, BPS participants showed decreased worrying and increased positive affect post-intervention; however, they did not show the expected greater increase in optimism. Within-person decreases in worrying were associated with decreased CARs, whereas both decreased worrying and increased PA were linked to attenuated stress reactivity. Results suggest that the BPS intervention can influence HPA axis reactivity, with effects on well-being variables likely mediating the process. More research is needed to determine longer-term neuroendocrine and health effects of such interventions in at-risk as well as healthy populations.

Influence of race on the effect of premature birth on salivary cortisol response to stress in adolescents

BACKGROUND

Adolescents born preterm have altered hypothalamic-pituitary-adrenal axis function with a blunted cortisol stress response, however, the influences of intrauterine growth restriction and race are unclear.

METHODS

We measured salivary cortisol before and 20 min after a maximal-exercise stress test and calculated the cortisol stress response. We used linear regression to compare cortisol stress responses between preterm and term groups, adjusting for birth weight z-score and maternal hypertension, and examined effect modification by race and sex.

RESULTS

We evaluated 171 adolescents born preterm with very low birth weight and 50 born term. Adolescents born preterm had reduced cortisol stress response compared to term (0.03 vs. 0.08 μg/dL, p = 0.04). This difference was race dependent: non-Black adolescents born preterm had significantly reduced cortisol stress response compared to those born at term (adjusted β: -0.74; 95% CI -1.34, -0.15), while there was no difference in Black adolescents (0.53; -0.16, 1.22). Sex did not modify the relationship.

CONCLUSIONS

Adolescents born preterm exhibit a reduced salivary cortisol response to exercise stress, suggesting long-term alterations in the hypothalamic-pituitary-adrenal axis. This relationship was evident in non-Black but not in Black adolescents, suggesting that race may modify the influence of preterm birth on stress alterations of the hypothalamic-pituitary-adrenal axis.

Good vibrations: An observational study of real-life stress induced by a stage performance

Stressors induce physiological changes in the brain and periphery that support adaptive defensive responses. The consequences of psychological stress on cognitive functioning are often measured in laboratory settings using experimentally induced stress that leads to mainly negative subjective feelings. There is a need for verification of these studies using real-life stressors that may potentially induce both positive and negative subjective feelings. In an observational study, we investigated real-life stress induced by voluntary stage performance at a large-scale music festival, including 126 participants (60 female, age range = 16-57 years). Our primary measurements involved salivary cortisol, heart rate, blood pressure, and positive and negative affect. In addition, participants completed a 2-back working memory task and a speeded decision-making task. We found that stage performance significantly increased salivary cortisol - with a particularly low number of cortisol non-responders - and heart rate, even when controlling for potential confounding factors, such as sleep, movement, and alcohol use. Interestingly, stage performance significantly decreased negative affect while increasing positive affect. This positively experienced stressor ("eustressor") was related to impaired working memory performance: the stronger the increases in cortisol, the slower participants responded to targets. Decision-making, however, was not affected. In conclusion, we show how stressful experiences in real-life can lead to positive affect, but still have a similar negative impact on cognitive functioning. We suggest that future research should focus more on the consequences of real-life stressors, and the consequences of eustress, in order to extend our understanding of the concept of psychological stress.

Investigation of cortisol dynamics in human sweat using a graphene-based wireless mHealth system

Understanding and assessing endocrine response to stress is crucial to human performance analysis, stress-related disorder diagnosis, and mental health monitoring. Current approaches for stress monitoring are largely based on questionnaires, which could be very subjective. To avoid stress-inducing blood sampling and to realize continuous, non-invasive, and real-time stress analysis at the molecular levels, we investigate the dynamics of a stress hormone, cortisol, in human sweat using an integrated wireless sensing device. Highly sensitive, selective, and efficient cortisol sensing is enabled by a flexible sensor array that exploits the exceptional performance of laser-induced graphene for electrochemical sensing. Herein, we report the first cortisol diurnal cycle and the dynamic stress response profile constructed from human sweat. Our pilot study demonstrates a strong empirical correlation between serum and sweat cortisol, revealing exciting opportunities offered by sweat analysis toward non-invasive dynamic stress monitoring via wearable and portable sensing platforms.

Fluctuations in progesterone moderate the relationship between daily mood and alcohol use in young adult women

BACKGROUND

Research has demonstrated associations between hormonal fluctuations during the menstrual cycle and women's alcohol use. This association has been explained by mood changes that, for some women, accompany decreasing levels of progesterone during the menstrual cycle, particularly during the late luteal/premenstrual phase. The current study examined whether participants' daily ratings of mood interact with changing levels of progesterone to predict alcohol use.

METHOD

Young adult women attended two sessions scheduled two weeks apart, during which they completed questionnaires and provided salivary samples for the assay of progesterone levels. In the intervening two weeks, participants completed daily logs of their mood, alcohol use, and menses. Ordered Generalized Linear Mixed Models assessed the effects of daily mood (examined as both a within- and between-subject variable) on the likelihood of drinking, as a function of menstrual cycle phase and changes in progesterone across the two weeks.

RESULTS

One standard deviation increase in progesterone corresponded to a 1.61 decrease in the odds of drinking. This main effect was moderated by daily mood. Women were more likely to drink during a decrease in progesterone on days they rated their mood as negative, whereas during an increase in progesterone they were more likely to drink on days they reported a positive mood. Between-subject analyses showed that women who reported lower overall mood during the two-week period were more likely to drink with an increase in progesterone and less likely with a decrease.

CONCLUSIONS

Women's likelihood to drink increased when they experienced negative mood in the context of decreasing levels of progesterone, whereas the negative-mood/drinking association was mitigated among those with increasing levels of progesterone. However, compared to women who on average had an overall more positive mood, women with an overall lower mood (and corresponding higher levels of depression and anxiety at baseline) did not experience the protective effects of rising progesterone levels on drinking.

Study of temporal variability of salivary cortisol and cortisone by LC-MS/MS using a new atmospheric pressure ionization source

There is a growing interest concerning the relevance of salivary cortisone levels in stress-related research. However, studies investigating morning patterns and day-to-day variability of cortisone versus cortisol levels are lacking. Cortisol and cortisone analysis by liquid chromatography-tandem mass spectroscopy (LC-MS/MS) has been widely used for routine laboratory measurements in the last years. The aim of this study was to develop an ultra-performance LC-MS/MS method for the simultaneous quantification of salivary cortisol and cortisone levels for assessing the temporal variability of these hormones. Saliva samples were collected from 18 healthy volunteers at 0, 15, and 30 min after awakening on each day for 1 week and analysed with the newly developed method. We used a novel atmospheric pressure ionization source, which resulted in high sensitivity and specificity for both cortisol and cortisone as well as higher peak values and signal-to-noise ratio as compared with the electrospray ionization source. Cortisone showed similar morning patterns as cortisol: a 25% and 49% increase in levels at 15 and 30 min after awakening, respectively. Most cortisone indices showed somewhat lower day-to-day variability and were less affected by state-related covariates. We recommend further exploration of the potential of salivary cortisone as a biomarker in stress-related research.