Cortisol response to synacthen stimulation is attenuated following abusive head trauma

• Published in: Clinical endocrinology (Oxford) Vol. 77; no. 3; pp. 357 - 362
• Main Authors: Heather, Natasha L., Derraik, José G. B., Brennan, Christine, Jefferies, Craig, Hofman, Paul L., Kelly, Patrick, Jones, Rhys G., Rowe, Deborah L., Cutfield, Wayne S.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-09-2012; Blackwell; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Brain Injuries - diagnosis; Brain Injuries - physiopathology; Child; Child Abuse - diagnosis; Child, Preschool; Cosyntropin - administration & dosage; Domestic Violence; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Humans; Hydrocortisone - blood; Hydrocortisone - secretion; Hypothalamo-Hypophyseal System - physiopathology; Infant; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Pituitary-Adrenal System - physiopathology; Pregnancy; Stress, Physiological - physiology; Traumas. Diseases due to physical agents; Vertebrates: endocrinology; Corticosteroid; Nervous system diseases; Steroid hormone; Craniocerebral; Adrenal hormone; Antiinflammatory agent; Stimulation; Cortisol; Head trauma; Hydrocortisone; Glucocorticoid; Endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2012.04376.x

Summary
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 ACTH1–24 (synacthen 1 μg IV) test, and serum cortisol response was compared between inflicted (TBII) and accidental (TBIA) groups.
Results
We assessed 64 children with TBII and 134 with TBIA. Boys were more likely than girls to suffer accidental (P < 0·001), but not inflicted TBI. TBII children displayed a 14% reduction in peak stimulated cortisol in comparison with the TBIA 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 TBII children having a mother who suffered domestic violence during pregnancy was 6·2 times that of the TBIA group (P < 0·001). However, reported domestic violence during pregnancy or placement of child in foster care did not appear to affect cortisol responses.
Conclusion
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.