Kariyawasam S Himani, Zaw Frank, Handley Sheila L
Diana, Princess of Wales Children's Hospital, Birmingham, UK.
Neuro Endocrinol Lett. 2002 Feb;23(1):45-8.
There is growing interest in the role of the hypothalamic-pituitary-adrenal (HPA) axis in neuropsychiatric disorders and there is some evidence that the HPA axis may be underfunctional in behaviorally disturbed children. However, co-morbidity is common in childhood neuropsychiatric disorders. Stimulant medication is widely used in the treatment of Attention-deficit hyperactivity disorder (ADHD) and can increase cortisol secretion when given acutely. We therefore set out to determine the whether salivary cortisol would be reduced in a group of children with ADHD/ODD (Oppositional-defiant disorder) and to examine the effect of stimulant medication on any such relationship.
Salivary cortisol was determined in thirty-two children with co-morbid ADHD and Oppositional-defiant disorder (ODD) according to DSM-IV criteria, compared to twenty-five healthy controls of similar age and ethnic background. Data were analysed according to prescription of stimulant medication in the patient group.
Salivary cortisol was significantly lower in the ADHD/ODD group than in the controls. Further analysis revealed that this reduction was restricted to the subgroup of patients not prescribed stimulant medication.
The results support the possibility of a dysfunction of control of the HPA axis in these behaviorally disturbed children. A reduction in salivary cortisol could reflect underarousal, an elevated threshold for detection of stressors or a subsensitivity of the HPA axis itself. It remains to be determined whether the ability of stimulant medications to negate the apparent deficit in cortisol secretion in these ADHD/ODD patients is an unrelated consequence of increased dopamine release or a reflection of their therapeutic benefit. The use of stimulant medication for co-existing ADHD should be taken into account in future studies of cortisol in behaviorally disturbed children.
下丘脑 - 垂体 - 肾上腺（HPA）轴在神经精神疾病中的作用日益受到关注，有证据表明HPA轴在行为紊乱儿童中可能功能不足。然而，共病在儿童神经精神疾病中很常见。兴奋剂药物广泛用于治疗注意力缺陷多动障碍（ADHD），急性给药时可增加皮质醇分泌。因此，我们着手确定一组患有ADHD /对立违抗障碍（ODD）的儿童唾液皮质醇是否会降低，并研究兴奋剂药物对这种关系的影响。
根据DSM - IV标准，对32名患有共病ADHD和对立违抗障碍（ODD）的儿童测定唾液皮质醇，并与25名年龄和种族背景相似的健康对照进行比较。根据患者组中兴奋剂药物的处方对数据进行分析。
ADHD / ODD组的唾液皮质醇显著低于对照组。进一步分析表明，这种降低仅限于未开处方使用兴奋剂药物的患者亚组。
结果支持这些行为紊乱儿童中HPA轴控制功能障碍的可能性。唾液皮质醇降低可能反映觉醒不足、应激源检测阈值升高或HPA轴本身的敏感性降低。兴奋剂药物消除这些ADHD / ODD患者中明显的皮质醇分泌不足的能力，究竟是多巴胺释放增加的无关结果还是其治疗益处的反映，仍有待确定。在未来对行为紊乱儿童皮质醇的研究中，应考虑使用兴奋剂药物治疗共存的ADHD。
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