Premium
Cortisol response to synacthen stimulation is attenuated following abusive head trauma
Author(s) -
Heather Natasha L.,
Derraik José G. B.,
Brennan Christine,
Jefferies Craig,
Hofman Paul L.,
Kelly Patrick,
Jones Rhys G.,
Rowe Deborah L.,
Cutfield Wayne S.
Publication year - 2012
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2012.04376.x
Subject(s) - medicine , traumatic brain injury , odds ratio , poison control , hydrocortisone , affect (linguistics) , endocrinology , head trauma , child abuse , injury prevention , psychology , psychiatry , medical emergency , surgery , communication
Summary Background Child abuse and other early‐life environmental stressors are known to affect the hypothalamic–pituitary–adrenal axis. We sought to compare synacthen‐stimulated cortisol responses in children who suffered inflicted or accidental traumatic brain injury ( TBI ). Methods Children with a history of early‐childhood TBI were recruited from the S tarship C hildren's H ospital database ( A uckland, N ew Z ealand, 1992–2010). All underwent a low‐dose ACTH 1–24 (synacthen 1 μg IV ) test, and serum cortisol response was compared between inflicted ( TBI I ) and accidental ( TBI A ) groups. Results We assessed 64 children with TBI I and 134 with TBI A . Boys were more likely than girls to suffer accidental ( P < 0·001), but not inflicted TBI . TBI I children displayed a 14% reduction in peak stimulated cortisol in comparison with the TBI A group ( P < 0·001), as well as reduced cortisol responses at + 30 ( P < 0·01) and + 60 min ( P < 0·001). Importantly, these differences were not associated with severity of injury. The odds ratio of TBI I children having a mother who suffered domestic violence during pregnancy was 6·2 times that of the TBI A group ( P < 0·001). However, reported domestic violence during pregnancy or placement of child in foster care did not appear to affect cortisol responses. Conclusion Synacthen‐stimulated cortisol response is attenuated following inflicted TBI in early childhood. This may reflect chronic exposure to environmental stress as opposed to pituitary injury or early‐life programming.