Basal and Adrenocorticotropic Hormone Stimulated Plasma Cortisol Levels Among Egyptian Autistic Children: Relation to Disease Severity

Abstract

BackgroundAutism is a disorder of early childhood characterized by social impairment, communication abnormalities and stereotyped behaviors. The hypothalamic-pituitary-adrenocortical (HPA) axis deserves special attention, since it is the basis for emotions and social interactions that are affected in autism.AimTo assess basal and stimulated plasma cortisol, and adrenocorticotropic hormone (ACTH) levels in autistic children and their relationship to disease characteristics.MethodsFifty autistic children were studied in comparison to 50 healthy age-, sex- and pubertal stage- matched children. All subjects were subjected to clinical evaluation and measurement of plasma cortisol (basal and stimulated) and ACTH. In addition, electroencephalography (EEG) and intelligence quotient (IQ) assessment were done for all autistic children.ResultsSixteen% of autistic patients had high ACTH, 10% had low basal cortisol and 10% did not show adequate cortisol response to ACTH stimulation. Autistic patients had lower basal (p = 0.032) and stimulated cortisol (p = 0.04) and higher ACTH (p = 0.01) than controls. Childhood Autism Rating Scale (CARS) score correlated positively with ACTH (r = 0.71, p = 0.02) and negatively with each of basal (r = -0.64, p = 0.04) and stimulated cortisol (r = -0.88, p < 0.001). Hormonal profile did not differ in relation to EEG abnormalities, IQ and self- aggressive symptoms.ConclusionsThe observed hormonal changes may be due to a dysfunction in the HPA axis in autistic individuals. Further studies are warranted regarding the role of HPA axis dysfunction in the pathogenesis of autism.

Are ASD and ADHD a Continuum? A Comparison of Pathophysiological Similarities Between the Disorders

“…Curin et al (2003), for example, found that individuals with autism had significantly lower serum concentrations of cortisol, p < 10(−6), and significantly higher concentrations of adrenocorticotropic hormone (ACTH), p = .002, than control ageand sex-matched participants. This was corroborated by Hamza, Hewedi, and Ismail (2010) who found that autistic patients had lower plasma basal (p = .032) and stimulated cortisol (p = .04) and higher ACTH (p = .01) than controls. They also found that the child's severity score, based on the CARS score, correlated positively with ACTH (r = .71, p = .02) and negatively with measures of basal (r = −.64, p = .04) and stimulated cortisol (r = −.88, p < .001).…”

Investigation of the serum levels of anterior pituitary hormones in male children with autism

“…An increase in ACTH levels in people with autism is the most consistent result reported from studies of anterior pituitary hormones [3,4,6,10]. In functional imaging studies of the limbic system, which is the neural basis of emotions and social interactions, people with autism have been shown to have impaired circuitry in extinguishing fear responses [21].…”

Elevated repetitive behaviors are associated with lower diurnal salivary cortisol levels in autism spectrum disorder

“…With regard to the regulation of this system, the activity of the HPA axis has differed in study populations with ASD depending on factors such as individual patterns of sensory sensitivity or stress levels, specific stress paradigm, or type of parameter assessed (saliva or plasma) (Brosnan et al, 2009;Corbett et al, 2006Corbett et al, , 2008Corbett et al, , 2009Hamza et al, 2010;Jansen et al, 2006;Zinke et al, 2010). In typically developing individuals, cortisol levels fluctuate with a diurnal rhythm; these levels begin to increase before awakening, show a rapid rise from awakening over the next 30-45 min, and then fall throughout the day, reaching a low point during the normal sleep cycle, to rise again in preparation for awakening (Clow et al, 2010).…”