title: Trauma exposure in relation to basal salivary cortisol and the hormone response to the dexamethasone/CRH test in male railway employees without lifetime psychopathology.
abstract: BACKGROUND
  Dysregulation of the hypothalamic-pituitary-adrenal (HPA)-axis is hypothesized to underlie stress-related psychiatric disorders such as post-traumatic stress disorder (PTSD). We aimed to explore whether trauma exposure is associated with alterations in HPA-axis functioning in the absence of lifetime psychiatric morbidity.
  
  
  METHODS
  We included 39 trauma-exposed healthy male subjects (mean age=47 years; SD=9.2) and 24 non-exposed healthy male controls (mean age=47.4 years; SD=14.5). All subjects were free of lifetime psychopathology. Basal salivary cortisol levels (on two consecutive days) as well as the cortisol and adrenocorticotropic hormone (ACTH) response to the combined dexamethasone/corticotropin releasing hormone (Dex/CRH) challenge test were analyzed using general linear models (GLM) adjusted for body mass index, age and smoking status.
  
  
  RESULTS
  A blunted salivary cortisol awakening response was found in the exposed group compared to the non-exposed group (F(1,57)=5.46, p=.02). Consistent with these findings, salivary diurnal cortisol was lower in the trauma-exposed versus non-exposed group (F(1,57)=4.04, p=.05). No differences, however, were found between both groups for plasma cortisol or ACTH responses to the Dex/CRH test.
  
  
  CONCLUSIONS
  Low basal cortisol levels were found in trauma-exposed men, suggesting that HPA-axis alterations in men are associated with trauma exposure during adulthood, also in the absence of psychopathology.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E.R.Klaassens@lumc.nl
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Klaassens
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Giltay
authors.forename: Tineke
authors.initials: T
authors.lastname: van Veen
authors.forename: Gerthe
authors.initials: G
authors.lastname: Veen
authors.forename: Frans G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D003346:Corticotropin-Releasing Hormone; D003907:Dexamethasone; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D009784:Occupational Diseases / Q000097:blood*; D010912:Pituitary-Adrenal Function Tests / Q000379:methods*; D012463:Saliva / Q000378:metabolism; D014947:Wounds and Injuries / Q000378:metabolism* / Q000523:psychology
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone