title: Salivary cortisol concentrations before and after carbon-dioxide inhalations in children.
abstract: BACKGROUND
  Considerable research implicates over-activity of the hypothalamic-pituitary adrenal axis in the pathophysiology of adult mood and anxiety disorders. The current study evaluates the association between salivary cortisol concentrations and response to carbon-dioxide inhalation in children and adolescents with anxiety disorders, mood disorders, or no psychiatric illness. The central question was whether response to carbon-dioxide inhalation is associated with levels of hypothalamic-pituitary adrenal axis activation. If confirmed, this would relate hypothalamic-pituitary adrenal axis activation in juveniles, as in adults, and response to a well-studied respiratory procedure.
  
  
  METHODS
  Serial salivary cortisol samples were examined in 98 subjects (ages 9-17 years), including 62 subjects with an anxiety and/or mood disorder and 36 nonpsychiatrically ill comparisons. Samples were obtained upon arrival at the laboratory, following a tilt test, then before and immediately after a standard 5% carbon dioxide inhalation procedure.
  
  
  RESULTS
  Salivary cortisol levels pre-carbon-dioxide inhalation were significantly higher in patients sensitive to the anxiogenic effects of carbon dioxide (n = 20) than in patients who did not respond to carbon dioxide (n = 42) and in healthy subjects, none of whom were sensitive to carbon dioxide (n = 36); cortisol concentrations in the latter two groups were indistinguishable. Salivary cortisol did not increase during carbon-dioxide inhalation, irrespective of diagnostic group or degree of reactivity to the procedure.
  
  
  CONCLUSIONS
  The current data resemble data from studies of laboratory-induced panic among adult patients. In both groups, activation of the hypothalamic-pituitary adrenal axis is associated with the response to a standardized stressor. Similarly, as in adults, carbon-dioxide inhalation in juveniles does not produce a significant change in hypothalamic-pituitary adrenal axis activation.
authors.affiliation: Department of Psychiatry, SUNY-Downstate, Brooklyn, NY, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Coplan
authors.forename: Donna
authors.initials: D
authors.lastname: Moreau
authors.forename: France
authors.initials: F
authors.lastname: Chaput
authors.forename: Jose M
authors.initials: JM
authors.lastname: Martinez
authors.forename: Christina W
authors.initials: CW
authors.lastname: Hoven
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Mandell
authors.forename: Jack M
authors.initials: JM
authors.lastname: Gorman
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Pine
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000188:drug therapy / Q000378:metabolism*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D012463:Saliva / Q000378:metabolism*
chemical_list: D002245:Carbon Dioxide; D006854:Hydrocortisone