Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression

Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus–pituitary–adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n = 26) with comorbid depression and a healthy comparison group (n = 26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA‐axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in‐patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.     

Effects of Perinatal Stress and Maternal Traumatic Stress on the Cortisol Regulation of Preterm Infants

Preterm infants experience intense stress during the perinatal period because they endure painful and intense medical procedures. Repeated activation of the hypothalamic–pituitary–adrenal (HPA) axis during this period may have long‐term effects on subsequent cortisol regulation. A premature delivery may also be intensely stressful for the parents, and they may develop symptoms of posttraumatic stress disorder (PTSD). Usable saliva samples were collected (4 times per day over 2 days, in the morning at awakening, at midday, in the afternoon, and in the evening before going to bed) to assess the diurnal cortisol regulation from 46 preterm infants when the infants were 12 months of corrected age (～ 14 months after birth). Mothers reported their level of PTSD symptoms. The results showed an interaction between perinatal stress and maternal traumatic stress on the diurnal cortisol slope of preterm infants (R² = .32). This suggests that the HPA axis of preterm infants exposed to high perinatal stress may be more sensitive to subsequent environmental stress.     

Interleukin 6 and cortisol in acute musculoskeletal disorders: results from a case‐referent study in Sweden

According to modern stress theory, the hypothalamo–pituitary–adrenocortical system (HPA axis) is an important part of the body's arousal system in physically straining (such as in infections) as well as in psychologically arousing situations. When demands for arousal have been excessively high for a long time, the HPA may show disturbance in its regulatory ability. Interleukins (IL) constitute an important part of the communication between the HPA axis and the immune system. The aim of the present study was to explore part of the circadian serum cortisol variation as well as interleukin 6 (IL‐6) in relation to acute low back and neck/shoulder pain and potential psychosocial stressors. In a defined geographical area, men and women who consulted any caregiver (traditional as well as alternative) for an acute spine pain condition preceded by six months without consultations constituted the case group. Age and gender matched men and women from the population register constituted the referent group. During an examination day all subjects went through ergonomic and psychosocial examinations (questionnaires, interviews and clinical examinations). Blood samples were drawn in the morning (8 am) as well as midday (noon) in a subsample of 243 individuals (86 cases and 157 referents) and analyzed for IL‐6 (midday sample) and cortisol (morning and midday sample). Female cases had higher IL‐6 levels (p<0.05) and those seeking care for low back pain had a smaller cortisol variation between morning and midday values than referents. In men, low self‐reported decision latitude at work (possibility to issue control) was significantly associated with higher IL‐6 concentration and low social support at work with low morning cortisol values. In women, high job satisfaction was associated with low IL‐6 concentrations and lower midday cortisol levels. Statistically strong correlations were found between IL‐6 and the degree of cortisol decrease between morning and midday (p<0.01). Reduced cortisol variation among female low back pain cases may indicate a disturbance in the HPA axis. A high IL‐6 level may arise in the course of a long‐lasting aroused psychosocial situation with concomitant impaired cortisol regulation. It could be speculated that the hormonal disturbances found reflect an impaired psychosocial state. Serum IL‐6 may be a useful serum marker for psychosocial adverse conditions in epidemiological studies. Copyright © 2000 John Wiley & Sons, Ltd.     

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.     

Correlates of hair cortisol concentrations in disadvantaged young children

Children from highly disadvantaged families tend to experience worse health, educational, and job outcomes than less disadvantaged peers. However, the mechanisms underlying these relationships remain to be explicated. In particular, few studies have investigated the relationships between the psychosocial influences that children are exposed to early in life and longer term cortisol output. This study aims to contribute to the literature by exploring how disadvantaged young children's experiences of family adversity, and parenting and family functioning, are related to their long‐term cortisol levels. A sample of 60 children (26 males, mean = 4.25 years, SD = 1.68) and their mothers (mean = 34.18 years, SD = 7.11) from a low‐income population took part in a single assessment. Mothers completed questionnaires on the family environment, parenting practices, and child behaviour. Children provided a hair sample for cortisol assay and anthropometric measures. A parsimonious multivariate regression model (including potential predictors identified by a selection algorithm) was used to investigate the correlates of hair cortisol concentration (HCC) in children. Higher levels of social exclusion, being male, and younger age were each associated with higher HCC. Maternal nurturing and emotion coaching were associated with lower HCC. Findings suggest that chronic stress may underlie relationships between adversity and its long‐term effects and that HCC offers a promising method for examining chronic stress in children and evaluating interventions by which it can be ameliorated.     

T2* Mapping of the Adult Intervertebral Lumbar Disc: Normative Data and Analysis of Diurnal Effects

In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3‐T scanner. Mid‐sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15‐min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1956–1962, 2019     

Trauma,attempted suicide,and morning cortisol in a community sample of adolescents

Individuals exposed to trauma or who have attempted suicide may show abnormal cortisol profiles; those exposed to significant trauma show reduced, while those who attempt suicide show increased cortisol output, although the evidence is inconsistent. This study explores the associations between morning cortisol, trauma, and suicide attempts or ideation among young people. In a community‐based sample of 501 15‐year‐olds, using data from a DSM‐IV‐compatible interview on suicidal‐behavior/ideation, trauma, and morning cortisol, we found no association between these factors and morning cortisol. A significant gender interaction was found for those threatened with a weapon—men showing a negative and women a positive association, suggesting that any cortisol/trauma association may be partially explained by coexisting behavioral problems and gender.     

Stress,symptoms of depression and anxiety,and cortisol patterns in working parents

Whether stress or psychological distress is associated with alterations in diurnal cortisol secretion patterns in healthy adults is still uncertain. In this study, the authors tested for associations between stress or symptoms of depression or anxiety and changes in diurnal cortisol patterns in 91 working parents (57 women and 34 men) across the United States. Saliva samples were collected for cortisol analysis at six timepoints over 2 days. The diurnal cortisol slope and time‐weighted average cortisol levels were analysed in relation to (1) two survey measures of stress, (2) diary reports of stress during cortisol sampling, and (3) self‐reported depression and anxiety. Cortisol slopes and average cortisol levels varied widely across individuals and within individuals across days. Only two of the 24 associations between stress or psychological symptoms and cortisol were significant at the p < 0.05 level; men with more severe symptoms of anxiety had significantly higher average cortisol levels and women who reported that work was more frequently stressful had significantly lower average cortisol levels. These results highlight the variability of diurnal cortisol secretion patterns in healthy adults and suggest that neither stress nor psychological symptomatology is a strong determinant of differences in diurnal cortisol patterns in healthy individuals. Copyright © 2004 John Wiley & Sons, Ltd.     

Psychosocial Factors and 2-Year Outcome Following Bariatric Surgery for Weight Loss

Background: How psychosocial factors may impact on weight loss after bariatric surgery is not well understood. This lack of knowledge is problematic, because there is a high prevalence of psychosocial distress in patients seeking treatment for obesity in hospital-based programs. The purpose of this study was to examine the relationship between preoperative psychosocial factors and eventual weight loss. Method: Between 1987 and 1998, all individuals undergoing Roux-en-Y gastric bypass for weight loss in our institution had psychologic preoperative evaluations. Patients who were followed prospectively were studied. The relation of having received mental health treatment to percentage of excess weight loss at 2 years is examined using t-tests. Results: 62 women and 18 men completed a 2-year follow-up. Patients who had received treatment for either substance abuse (n=10) or psychiatric co-morbidity (n=39) lost more weight compared with those without such histories (P<0.05, P <0.001 respectively). Conclusion: Given these results, it is plausible that a history of having received either psychiatric treatment for a disorder or counseling for substance abuse should not be a contraindication to bariatric surgery, and, in fact, may be prognostic of favorable outcome. Further research examining psychosocial factors and outcome from bariatric surgery is clearly warranted.     

Psychosocial,Demographic, and Illness‐Related Factors Associated With Acute Traumatic Stress Responses in Parents of Children With a Serious Illness or Injury

This study investigated factors associated with acute stress symptoms in parents of seriously ill children across a range of illnesses and treatment settings within a pediatric hospital setting. It was hypothesized that psychosocial variables would be more strongly associated with acute stress responses than demographic and child illness variables. Participants were 115 mothers and 56 fathers of children treated within the oncology, cardiology, and intensive care departments of a pediatric hospital. Acute stress, psychosocial, demographic, and medical data were collected within the first 4 weeks of the child's hospital admission. A robust hierarchical regression model revealed that psychosocial factors significantly explained 36.8% of the variance in parent acute stress responses (p < .001); demographic variables significantly added a further 4.5% (p = .022), but illness‐related factors did not contribute to the model. Findings support the implementation of a general psychosocial screening approach for parents across the wider hospital system, and that psychosocial risk factors may be targeted in interventions across different illnesses and treatment settings to improve parent outcomes.     

The Effect of Modifying Dietary Calcium Intake Pattern on the Circadian Rhythm of Bone Resorption

In order to assess day-to-day variations of the circadian rhythm of biochemical bone resorption markers, urinary morning (6–8 a.m.) and evening (7–10 p.m.) samples from 35 individuals were monitored during 3 subsequent days. The bone-specific deoxypyridinoline (DPD) crosslinks of type I collagen followed a circadian rhythm in all individuals. In contrast, no such pattern was observed in the urinary hydroxyproline/creatinine and calcium/creatinine measurements. The DPD crosslink measurements showed a much larger difference between the morning and evening samples collected within 1 day compared with the variation between the samples collected in the morning or evening on subsequent days, indicating the importance of adequate timing of urine sampling for clinical trials aiming to monitor effects on bone resorption. The analysis of DPD crosslinks was then used to evaluate the effects of different patterns of dietary calcium intake on the circadian rhythm of bone resorption in osteoporotic patients. No significant effect on the circadian rhythm of the DPD crosslinks was found after concentrating the normal daily calcium intake to the evening (6–10 p.m.) during 8 days (n = 7). Ingestion of a dietary calcium supplement (600 mg) at 10 p.m. during 8 days (n = 7) resulted in an increased urinary calcium excretion in the morning, and a flattening of the circadian peak and nadir concentrations of urinary DPD/creatinine. The absolute levels of DPD/creatinine in the morning and evening urine samples, respectively, were not significantly altered compared with the control day. We conclude that dietary calcium supplementation in the evening only marginally affects the circadian rhythm of urinary DPD crosslinks in established osteoporosis patients. Received: 23 December 1996 / Accepted: 1 November 1998     

The Relationship Between Work‐Related Rumination and Evening and Morning Salivary Cortisol Secretion

The perseverative cognition hypothesis suggests that worry/ruminative thinking prolongs stress‐related physiological activation. This study explored the association of work‐related rumination with salivary cortisol sampled at 10pm and the cortisol awakening response (CAR) the following morning. On a mid‐week evening, 108 school teachers completed a small diary about their work‐related thoughts and gave a saliva cortisol sample at 10pm. The following morning, they gave four additional saliva samples: at awakening and at 15, 30 and 45 min after awakening, along with a rating of their anticipatory thoughts about work. The CAR was calculated as the percentage increase in cortisol secretion from awakening to 30 min, and the sample was divided at their respective medians to classify participants into low and high rumination groups. Cortisol secretion was found to be significantly greater in the high compared with the low ruminators at 10pm, and this effect was not related to leisure activities or work patterns during the evening. For the morning measures, high ruminators demonstrated a flattened CAR relative to the low ruminators, and this effect appeared to be associated with sleep disturbance during the night. Ruminating about work‐related issues is associated with cortisol secretion, and our findings support the perseverative cognition hypothesis. Copyright © 2013 John Wiley & Sons, Ltd.     

Age of Trauma Onset and HPA Axis Dysregulation Among Trauma‐Exposed Youth

The hypothalamic–pituitary–adrenal axis (HPA axis) is a pathway through which childhood trauma may increase risk for negative health outcomes. The HPA axis is sensitive to stress throughout development; however, few studies have examined whether timing of exposure to childhood trauma is related to differences in later HPA axis functioning. Therefore, we examined the association between age of first trauma and HPA axis functioning among adolescents, and whether these associations varied by sex. Parents of 97 youth (aged 9–16 years) completed the Early Trauma Inventory (ETI), and youth completed the Socially‐Evaluated Cold‐Pressor Task (SECPT). We measured salivary cortisol response to the SECPT, the cortisol awakening response, and diurnal regulation at home across 2 consecutive weekdays. Exposure to trauma during infancy related to delayed cortisol recovery from peak responses to acute stress, d = 0.23 to 0.42. Timing of trauma exposure related to diverging patterns of diurnal cortisol regulation for males, d = 0.55, and females, d = 0.57. Therefore, the HPA axis may be susceptible to developing acute stress dysregulation when exposed to trauma during infancy, whereas the consequences within circadian cortisol regulation may occur in the context of later trauma exposure and vary by sex. Further investigations are warranted to characterize HPA axis sensitivity to exposure to childhood trauma across child development.     

Perioperative myocardial cell injury: the relationship between troponin T and cortisol

STUDY OBJECTIVE: To investigate whether there is an association between Troponin T (TnT), reflecting myocardial cell injury, and cortisol, reflecting the degree of surgical trauma and associated stress, in light of our recent evaluation of TnT as a marker of perioperative myocardial cell injury.DESIGN: Prospective, cohort study.PATIENTS: 70 patients (67.4 +/- 8.7 yrs) with definite or at-risk coronary artery disease (CAD) undergoing elective noncardiac surgery (vascular n = 38, abdominal n = 21, orthopedic n = 8) with general (n = 63) or regional (n = 4) anesthesia with postoperative on-demand analgesia.MEASUREMENTS AND MAIN RESULTS: Morning blood samples for TnT (upper limit of normal: <0.2 ng/mL), CK-MB (reference range 相似文献   

General Anesthesia for Surgery Influences Melatonin and Cortisol Levels

The purpose of this study was to investigate the effect of general anesthesia and surgery on melatonin production, and to assess the relationship between melatonin secretion and cortisol levels. Twenty (9 males and 11 females) consecutive otherwise healthy patients aged 27 to 52 years were included in this study. The patients underwent laparoscopic cholecystectomy or laparoscopic hernioplasty. All patients had general anesthesia with the same anesthetic drugs. Serum cortisol levels were measured at several time periods. Urine collections for melatonin were performed from 18:00 to 7:00 the day prior to surgery, on the operation day, and on the first postoperative day. Baseline melatonin metabolites were measured the night prior to surgery, and the level was found to be 1979 ± 1.76 ng. The value decreased to 1802 ± 1.82 ng (NS) on the night of surgery, and it became a significantly higher, reaching 2981 ± 1.55 ng the night after surgery (p = .003). The baseline daytime cortisol level was significantly lower than the baseline night cortisol level (6.87 ± 1.51 μg/dl, 14.89 ± 1.66 micrograms/dl, respectively, p < 0.0001). Surgery induced a significant increase in both day and night cortisol levels. Daytime cortisol levels increased from 6.89 ± 1.51μg/dl to 16.90 ± 1.27μg/dl (p < 0.0001), whereas right levels increased from 14.89 ± 1.66 μg/dl to 29.20 ± 1.24 μg/dl (p <0.0001). The morning after surgery, cortisol levels decreased to 10.16 ± 1.40 μg/dl, lower than the value obtained on the day of surgery (p < 0.0001). As was true of melatonin, cortisol levels did not reach the pre operative level (p < 0.005). The finding of the current study is that melatonin and cortisol levels show an inverse correlation after surgery.     

Stress,inflammatory markers and factors associated in patients with type 2 diabetes mellitus

Stress is evaluated using tumour necrosis factor‐α (TNF‐α), Heat Shock Protein 60 (Hsp60) and other markers in chronic diseases. We examined the association of Hsp60, cortisol, TNF‐α and interleukin‐6 (IL‐6) serum levels with psychological and socio‐economic factors in patients with type 2 diabetes mellitus (DM‐2). We studied 151 DM‐2 patients in groups with <1 year and >5 years since diagnosis. Clinical data, family income and questionnaires of anxiety, depression, perceived stress, social support, glucose, glycated haemoglobin, lipids, Hsp60, cortisol, IL‐6 and TNF‐α were collected. Patients with >5 years since diagnosis of DM‐2 had lower body mass index (p < 0.016), higher glucose (p < 0.005) and HbA_1c (p < 0.005) levels. The group of recent diagnosis had higher Hsp60 (p < 0.00003). Hsp60 was associated negatively with years since diagnosis (p < 0.000012), and positively with glucose (p < 0.029). Cortisol was positively associated with glucose levels (p < 0.019) and family income (p < 0.037). TNF‐α was associated with years since diagnosis (p < 0.004) and perceived stress (p < 0.018). At early stages of DM‐2, Hsp60 increases with glucose levels, cortisol is associated with glucose levels. At later stages TNF‐α increases, associated with perceived stress. Copyright © 2007 John Wiley & Sons, Ltd.     

Psychological and Environmental Correlates of HPA Axis Functioning in Parentally Bereaved Children: Preliminary Findings

This study examined bereaved children's HPA‐axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self‐report instruments and in‐person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = ?.45), depression (r = ?.40), posttraumatic stress (r = ?.45), and maladaptive grief (r = ?.43), as well as higher levels of avoidant coping (r = ?.53). Higher levels of parental maladaptive grief were also associated (r = ?.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.     

Predicting pediatric posttraumatic stress disorder after road traffic accidents: the role of parental psychopathology

This study examined prospectively the role of parental psychopathology among other predictors in the development and persistence of posttraumatic stress disorder (PTSD) in 57 hospitalized youths aged 7-18 years immediately after a road traffic accident and 1 and 6 months later. Self report questionnaires and semistructured diagnostic interviews were used in all 3 assessments. Neuroendocrine evaluation was performed at the initial assessment. Maternal PTSD symptomatology predicted the development of children's PTSD 1 month after the event, OR = 6.99, 95% CI [1.049, 45.725]; the persistence of PTSD 6 months later was predicted by the child's increased evening salivary cortisol concentrations within 24 hours of the accident, OR = 1.006, 95% CI [1.001, 1.011]. Evaluation of both biological and psychosocial predictors that increase the risk for later development and maintenance of PTSD is important for appropriate early prevention and treatment.     

Systemic activity of inhaled corticosteroid treatment in asthmatic children: corticotrophin releasing hormone test

BACKGROUND: A study was undertaken to assess the function of the hypothalamic-pituitary-adrenal axis (HPA) in a group of asthmatic children before and after treatment with inhaled corticosteroids. METHODS: Thirty prepubertal patients of mean (SD) age 6.7 (1.8) years were treated with inhaled corticosteroids. All children underwent a corticotrophin releasing hormone (CRH) test with evaluation of serum cortisol and adrenocorticotrophin hormone (ACTH) levels before and after 3 months of treatment. Twenty four hour urine samples were also collected to measure free cortisol (UFC) excretion. RESULTS: Subjects showed no difference between basal serum cortisol levels (mean change -18; 95% CI -41 to 5; p=0.118) and delta (peak minus basal) levels (mean change -13; 95% CI -38 to 12; p=0.308) before and after treatment, whereas the peak cortisol level (mean change -31; 95% CI -55 to -7; p=0.013) and area under the curve (AUC) (mean change -175; 95% CI -288 to -63; p=0.003) after CRH were significantly lower following treatment. Basal, peak and AUC ACTH were significantly lower after treatment (p<0.05, p=0.004 and p=0.003, respectively), while delta ACTH was similar before and after treatment ((mean change -12; 95% CI - 31 to -7; p=0.199). No significant reduction in 24 hour UFC was observed after the treatment period (before 14.9 (7.1), after 15.0 (11.6); mean change 0.1, 95% CI -5.2 to 5.4; p=0.967). No correlation was found between UFC and any of the parameters of cortisol excretion following the CRH test, either before or after treatment. CONCLUSIONS: These data suggest that, at the dosage and for the treatment period used, inhaled steroids do not seem to suppress the HPA axis in the majority of patients. The CRH test may be more sensitive than 24 hour UFC and morning plasma cortisol levels in evaluating systemic activity of inhaled corticosteroid treatment.     

Hormone levels in male ice hockey players during a 26-hour cup tournament

Pituitary, adrenal and testicular hormones and steroid-binding proteins were analysed in 15 active ice hockey players and in 16 spectators, matched for physical fitness, during a 26-h cup tournament including three matches. Diurnal variations were noted for all compounds except FSH and SHBG. The levels of cortisol, dehydroepiandrosterone (DHA), 4-androstene-3, 17-dione (A-4) and prolactin increased in players but not in spectators following the matches played in the afternoons, but not following the match played in the morning. Albumin and DHA sulphate (DHAS) levels increased in players following all three matches and SHBG levels increased slightly in players following the afternoon matches, all probably due to haemoconcentration. DHAS and albumin showed simultaneous diurnal variations with a nadir in the morning. 17 alpha-hydroxyprogesterone (17-OHP) and total and non-SHBG-bound testosterone showed similar diurnal patterns in spectators, with maximum levels in the morning. Levels of 17-OHP were largely unaffected by physical stress, while the morning maximum for total and non-SHBG-bound testosterone was completely abolished in players. Minor or insignificant changes were noted for LH and FSH. While the changes in unconjugated adrenal steroids (cortisol, DHA and A-4) reflect changes in acute ACTH stimulation, changes in albumin binding may be more important for the short-term variations in levels of DHAS. The influence of physical stress upon the pattern of testosterone may be mediated mainly by inhibition of testicular steroidogenesis by elevated cortisol and/or prolactin levels, rather than by decreased gonadotrophic stimulation or by alterations in binding to SHBG.