title: The hyporeactivity of salivary cortisol at stress test (TSST-C) in children with internalizing or externalizing disorders is contrastively associated with α-amylase.
abstract: BACKGROUND
  Stress biomarkers of the autonomic nervous system and hypothalamic-pituitary-adrenal axis (HPA-axis) can be measured via alpha-amylase (AA) and cortisol and cortisone in saliva. Objectives were to determine 1) the response patterns of cortisol, cortisone, and AA under both circadian conditions and the Trier Social Stress Test for Children (TSST-C), 2) which reactivity index is most suitable to differentiate internalizing or externalizing disorders from controls, and to explore 3) the interaction between AA and cortisol in the presence of internalizing or externalizing disorders.
  
  
  METHODS
  Saliva samples (n = 2893) from children with internalizing (n = 55) or externalizing disorders (n = 33) and healthy children (n = 81) were analyzed for cortisol, cortisone, and AA under circadian conditions and TSST-C.
  
  
  RESULTS
  Circadian rhythm of three biomarkers did not differ between diagnostic groups. Age and gender were significant predictors for cortisol and awakening time influenced all three biomarkers significantly. TSST-C responses appeared sequentially in the order of AA, cortisol, and cortisone. Trajectories of cortisol and cortisone responses, not in AA, were significantly lower in children with internalizing or externalizing disorders than in healthy children. Cortisol percentage increase appeared to be the most suitable reactivity index to detect the difference between the diagnostic groups. Internalizing disorders had a negative association between AA decrease and cortisol increase (β = -.199, p < .05, R(2) = .304). Externalizing disorders had a positive association between AA baseline and cortisol increase (β = .229, p < .05, R(2) = .304).
  
  
  CONCLUSIONS
  An altered HPA-axis response during stress might result from chronic allostatic load in internalizing disorders and underaroused stress response system in externalizing disorders.
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany. Electronic address: Yoonju.Bae@medizin.uni-leipzig.de.
authors.forename: Yoon Ju
authors.initials: YJ
authors.lastname: Bae
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany. Electronic address: sstadelmann@life.uni-leipzig.de.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stadelmann
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany. Electronic address: Annette.Klein@medizin.uni-leipzig.de.
authors.forename: Annette Maria
authors.initials: AM
authors.lastname: Klein
authors.affiliation: LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany. Electronic address: sjaeger@life.uni-leipzig.de.
authors.forename: Sonia
authors.initials: S
authors.lastname: Jaeger
authors.affiliation: LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital, University of Leipzig, Germany. Electronic address: ahiemisch@life.uni-leipzig.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hiemisch
authors.affiliation: Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital, University of Leipzig, Germany. Electronic address: Wieland.Kiess@medizin.uni-leipzig.de.
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany. Electronic address: Uta.Ceglarek@medizin.uni-leipzig.de.
authors.forename: Uta
authors.initials: U
authors.lastname: Ceglarek
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany. Electronic address: Alexander.Gaudl@medizin.uni-leipzig.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gaudl
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany. Electronic address: Michael.Schaab@medizin.uni-leipzig.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Schaab
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany. Electronic address: Kai.Klitzing@medizin.uni-leipzig.de.
authors.forename: Kai
authors.initials: K
authors.lastname: von Klitzing
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany. Electronic address: Joachim.Thiery@medizin.uni-leipzig.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Thiery
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany. Electronic address: Juergen.Kratzsch@medizin.uni-leipzig.de.
authors.forename: Juergen
authors.initials: J
authors.lastname: Kratzsch
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany. Electronic address: Mirko.Doehnert@medizin.uni-leipzig.de.
authors.forename: Mirko
authors.initials: M
authors.lastname: Döhnert
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D003348:Cortisone / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D001523:Mental Disorders / Q000378:metabolism*; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012463:Saliva / Q000378:metabolism*; D013315:Stress, Psychological / Q000378:metabolism*; D000516:alpha-Amylases / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D000516:alpha-Amylases; D003348:Cortisone; D006854:Hydrocortisone
keywords: Alpha-amylase; Circadian rhythm; Cortisone; Psychiatric disorders; Salivary cortisol; Trier social stress test for children (TSST-C)