title: Cortisol response to synacthen stimulation is attenuated following abusive head trauma.
abstract: 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 Starship Children's Hospital database (Auckland, New Zealand, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liggins Institute, University of Auckland, New Zealand.
authors.forename: Natasha L
authors.initials: NL
authors.lastname: Heather
authors.forename: José G B
authors.initials: JG
authors.lastname: Derraik
authors.forename: Christine
authors.initials: C
authors.lastname: Brennan
authors.forename: Craig
authors.initials: C
authors.lastname: Jefferies
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hofman
authors.forename: Patrick
authors.initials: P
authors.lastname: Kelly
authors.forename: Rhys G
authors.initials: RG
authors.lastname: Jones
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Rowe
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Cutfield
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003366:Cosyntropin / Q000008:administration & dosage; D017579:Domestic Violence; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007223:Infant; D008297:Male; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011247:Pregnancy; D013312:Stress, Physiological / Q000502:physiology
chemical_list: D003366:Cosyntropin; C006418:adrenocorticotropin zinc; D006854:Hydrocortisone