Table 1.
Hypothalamic pituitary adrenal axis functioning and its relationship with childhood traumata and psychopathology in post-traumatic stress disordered patients
| Author | Control group | Sample | Cortisol levels | ACTH levels | Suppression (DST) | Stress test | Correlations with childhood traumata and psychopathology |
| Lemieux et al[46], 1995 | 9 non abused women; 8 abused women w/o PTSD | 11 abused women with PTSD | ↑ Basal urinary levels | - | - | - | ↑ Scores on Impact Event Scale related to cortisol levels in PTSD sample |
| De Bellis et al[48], 1999 | 10 non-traumatized children; 24 healthy controls | 18 children with PTSD due to childhood maltreatment | ↑ Basal urinary levels | - | - | - | ↑ Psychopathology |
| Bremner et al[66], 2003 | 18 HC | 23 patients with abuse-related PTSD | Salivary cortisol: 61% higher | - | - | Cognitive challenge | Neurohormonal response to stress in PTSD subjects is not impaired |
| Waiting for test; 46% higher during test | |||||||
| Luecken[52], 1998 | 31 HC | 30 students who lost one parent before age 16 | ↑ Salivary levels post task | - | - | Video clip depicting the death of a parent + speech task | Altered neurohormonal responses to stress in those who lost one parent |
| Elzinga et al[53], 2003 | 12 abused women without PTSD | 12 abused women with PTSD | Salivary cortisol: 60% higher waiting for test; 122% higher during test; 69% higher during recovery | - | - | Personalized trauma scripts | Altered neurohormonal responses to stress in PTSD abused women |
| Rasmusson et al[56], 2001 | 11 HC | 12 outpatients with PTSD | = Plasma basal levels; ↑ plasma and urinary post tests levels | = Basal levels; ↑ post CRF levels | - | CRF and ACTH stimulation tests | Altered neurohormonal responses to stress in PTSD subjects |
| Santa Ana et al[57], 2006 | 31 HC | 58 subjects with PTSD (25 with childhood trauma) | ↓ Plasma basal and post | ↓ Post task | - | Cold Pressor Task | - |
| Task, if childhood trauma | |||||||
| De Bellis et al[58], 1994 | 13 HC girls | 13 sexually abused girls | = Plasma and salivary basal and post CRH | ↓ Basal and post CRH | - | CRH stimulation test | ↑ Adult psychopathology and altered hormonal responses to stress |
| Stein et al[61], 1997 | 21 non abused women | 19 children and/or adolescent with sexual abuse | - | - | ↑ | Low dose DST (0.5 mg) | ↑ Adult psychopathology |
| Yehuda et al[31], 2004 | 10 non traumatized subjects | 52 traumatized subjects | - | - | ↑ | Low dose DST (0.5 mg) | - |
| Jovanovic et al[59], 2010 | 61 traumatized non PTSD subjects | 29 traumatized PTSD subjects | = Basal plasma levels; ↓ post Dex plasma levels | ↓ Post Dex | ↑ | Low dose DST (0.5 mg) | Abnormalities of HPA feedback and ↑ psychopathology |
| Altemus et al[62], 2003 | 15 HC | 16 women with PTSD due to childhood abuse | = Basal plasma and salivary levels | - | - | - | - |
| Lindley et al[47], 2004 | 17 HC | 17 subjects with PTSD (88% due to childhood trauma) | ↑ Basal salivary levels | - | = | Low dose DST (0.5 mg) | No correlations between cortisol, childhood abuse and psychopathology |
HC: Healthy controls; DST: Dexamethasone suppression test; PTSD: Posttraumatic stress disorder; ACTH: Adrenocorticotropin hormone; CRH: Corticotropin releasing hormone; CRF: Corticotropin releasing factor.