Is HPA axis reactivity in childhood gender-specific? A systematic review

Abstract

BackgroundIn adults, hypothalamus–pituitary–adrenal (HPA) axis activity shows sexual dimorphism, and this is thought to be a mechanism underlying sex-specific disease incidence. Evidence is scarce on whether these sex differences are also present in childhood. In a meta-analysis, we recently found that basal (non-stimulated) cortisol in saliva and free cortisol in 24-h urine follow sex-specific patterns. We explored whether these findings could be extended with sex differences in HPA axis reactivity.MethodsFrom inception to January 2016, PubMed and EMBASE.com were searched for studies that assessed HPA axis reactivity in healthy girls and boys aged ≤18 years. Articles were systematically assessed and reported in the categories: (1) diurnal rhythm, (2) cortisol awakening response (CAR), (3) protocolled social stress tests similar or equal to the Trier Social Stress Test for children (TSST-C), (4) pharmacological (ACTH and CRH) stress tests, and (5) miscellaneous stress tests.ResultsTwo independent assessors selected 109 out of 6158 records for full-text screening, of which 81 studies (with a total of 14,591 subjects) were included. Studies showed that girls had a tendency towards a more variable diurnal rhythm (12 out of 29 studies), a higher CAR (8 out of 18 studies), and a stronger cortisol response to social stress tests (9 out of 21 studies). We found no evidence for sex differences in cortisol response after a pharmacological challenge or to miscellaneous stress tests.DiscussionSex differences in HPA axis reactivity appear to be present in childhood, although evidence is not unequivocal. For a better evaluation of sex differences in HPA axis reactivity, standardization of protocols and reports of stress tests is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s13293-017-0144-8) contains supplementary material, which is available to authorized users.

An inactive control of the ‘Trier Social Stress Test’ for Youth 10–17 years: Neuroendocrine, cardiac, and subjective responses

“…This finding is consistent with previous studies reporting cortisol reactivity of sex differences only in older adults, and not in adolescents or children (Kudielka et al, 2004;Strahler et al, 2010). Our findings add to the research that sex effects in cortisol reactivity appear to be absent or inconclusive in children and adolescents (Hollanders et al, 2017). Boys and girls respond to the TSST-C in a similar fashion.…”

“…Given the interaction between cortisol and sexual hormones, the puberty-HPA stress hypothesis proposes that increased stress response accompanies sexual maturation (Gunnar et al, 2009). However, sex differences in cortisol reactivity are inconclusive (Hollanders, Van Der Voorn, Rotteveel, & Finken, 2017). Some studies reported sex differences in adults, but not in adolescents or children (Strahler et al, 2010;Yim et al, 2010).…”

Cortisol Impacted on Explicit Learning Encoding, but Not on Storage and Retrieval, and Was Not Associated With Sleep Patterns—Results From the Trier Social Stress Test for Children (TSST-C) Among 9-Years Old Children

“…More specifically, we hold that with the present study we expanded upon the current literature in the following important ways. First, we performed this study with 9-years old children, and following Hollanders et al ( 2017 ) research on stress-axis reactivity on social stress was mainly performed with 8-years old, or 10- to 16-years old children and adolescents. Second, to the best of our knowledge, no study has investigated the influence of the TSST-C on figural memory performance.…”

“…To test our hypotheses and to examine our research questions, a sample of 39 children aged about 9 years were assessed in their cognitive performance and cortisol levels before and after a psychosocial stress, along with the objective sleep and cortisol levels in the morning. We had two reasons to assess 9 years old children: First, Hollanders et al ( 2017 ) showed in their systematic review on the cortisol secretion under the TSST-C that mainly children and adolescents at the age of 8, and 10 to 16 years were assessed, while research on 9 years old children was less frequent. Second, the present sample belongs to a larger sample of a long-term study on the associations between psychological functioning, sleep and cortisol secretion; children were assessed at the age of 5, 6, 9, and 14 years, and here, we present data of children at the age of 9 years.…”

Day‐to‐day friends’ victimization, aggression perpetration, and morning cortisol activity in late adolescents

“…Sex might further moderate the effect of cortisol on daily victimization-aggression links. Male compared to female adolescents have often been found to show lower morning cortisol increase and total output (Hollanders, van der Voorn, Rotteveel, & Finken, 2017). In addition, associations between low morning cortisol and higher total aggression have been sometimes found for male adolescents only (Dietrich et al, 2013;Shirtcliff et al, 2005;Sondeijker et al, 2008).…”