title: Cortisol Response to Stress in Adults with Attention Deficit Hyperactivity Disorder.
abstract: BACKGROUND
  Differences in the cortisol response have been reported between children exhibiting the inattentive and hyperactive/impulsive subtypes of attention deficit hyperactivity disorder. However, there is no such information about adults. The aim of the present study was to determine the possible differences between the combined and inattentive subtypes in the cortisol response to stress.
  
  
  METHODS
  Ninety-six adults with attention deficit hyperactivity disorder, 38 inattentive and 58 combined, without any medical or psychiatric comorbidities and 25 healthy controls were included. The Trier Social Stress Test was used to assess physiological stress responses. Clinical data and subjective stress levels, including the Perceived Stress Scale, were also recorded.
  
  
  RESULTS
  No significant differences in the cortisol response to the Trier Social Stress Test were found between patients and controls. However, albeit there were no basal differences, lower cortisol levels at 15 (P=.015), 30 (P=.015), and 45 minutes (P=.045) were observed in the combined compared with the inattentive subtype after the stress induction; these differences disappeared 60 minutes after the stress. In contrast, the subjective stress responses showed significant differences between attention deficit hyperactivity disorder patients and controls (P<.001), but no differences were seen between attention deficit hyperactivity disorder subtypes. In turn, subjective stress measures, such as the Perceived Stress Scale, positively correlated with the whole cortisol stress response (P<.027).
  
  
  CONCLUSIONS
  Both the combined and inattentive attention deficit hyperactivity disorder adults exhibited a normal cortisol response to stress when challenged. Nevertheless, the inattentive patients displayed a higher level of cortisol after stress compared with the combined patients. Despite the differences in the cortisol response, adults with attention deficit hyperactivity disorder reported high levels of subjective stress in their every-day life.
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R). mcoromin@vhebron.net mgtc@neuroclassics.org.
authors.forename: Margarida
authors.initials: M
authors.lastname: Corominas-Roso
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Gloria
authors.initials: G
authors.lastname: Palomar
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Roser
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Alberto
authors.initials: A
authors.lastname: Real
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Mariana
authors.initials: M
authors.lastname: Nogueira
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Montserrat
authors.initials: M
authors.lastname: Corrales
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Miguel
authors.initials: M
authors.lastname: Casas
authors.affiliation: Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
authors.forename: Josep Antoni
authors.initials: JA
authors.lastname: Ramos-Quiroga
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000378:metabolism*; D013997:Time Factors; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: ADHD; Attention deficit hyperactivity disorder; cortisol; hypothalamic pituitary adrenal axis; inhibitory deficits; stress