Low cortisol and a flattening of expected daytime rhythm: Potential indices of risk in human development
Abstract
Since the work of Hans Selye, stress has been associated with increased activity of the limbic–hypothalamic– pituitary–adrenocortical (LHPA) axis. Recently, a number of studies in adults have shown that this neuroendocrine axis may be hyporesponsive in a number of stress-related states. Termed hypocortisolism, the paradoxical suppression of the LHPA axis under conditions of trauma and prolonged stress presently challenges basic concepts in stress research. Adverse conditions that produce elevated cortisol levels early in life are hypothesized to contribute to the development of hypocortisolism in adulthood. However, as reviewed in this paper, hypocortisolism also may be a common phenomenon early in human childhood. Although preliminary at this point, the ubiquity of these findings is striking. We argue that developmental studies are needed that help explicate the origins of low cortisol and to determine whether the development of hypocortisolism is, in fact, preceded by periods of frequent or chronic activation of the LHPA axis. We also argue that developmental researchers who incorporate measures of salivary cortisol into their studies of at-risk populations need to be aware of the hypocortisolism phenomenon. Lower than expected cortisol values should not necessarily be relegated to the file drawer because they contradict the central dogma that stress must be associated with elevations in cortisol. Lastly, we note that evidence of low cortisol under adverse early life conditions in humans adds to the importance of understanding the implications of hypocortisolism for health and development.
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The cortisol pattern in early abused/high internalizing children is consistent with HPA axis dysregulation seen in adults and children under chronic stress.
“The pattern of cortisol production noted for the early abused/high internalizing children provided consistent evidence of HPA axis dysregulation as noted in adults and children under chronic stress (Gunnar & Vazquez, 2001; Heim et al., 2000, 2008; Miller et al., 2007).”
From The Differential Impacts of Early Physical and Sexual Abuse and Internalizing Problems on Daytime Cortisol Rhythm in School-Aged Children (2010) · cites this paper as Gunnar & Vazquez, 2001
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Llorens, M., Barba, M., Torralbas-Ortega, J., Nadal, R., Armario, A., Gagliano, H., Urraca, L., Pujol, S., Montalvo, I., Gracia, R., et al. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2281752 · Cited by 8 · see citing works
Matthaeus, H., Heim, C., Voelkle, M. C., & Singer, T. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1277929 · Cited by 6 · see citing works
“Given that low cortisol can also indicate a heightened vulnerability associated with a blunted stress response, which is considered detrimental (65 – 67), we investigated potential distinctions among the three groups within our study ’ s overall healthy TSST sample.”
Background
- Authors
- GUNNAR, M. R., & VAZQUEZ, D. M.
- Affiliations
- University of Minnesota (US)
- ORCID
- GUNNAR, MEGAN R.
- Venue
- Development and Psychopathology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2001-09
- Volume
- 13
- Issue
- 3
- Pages
- 515-538
- ISSN
- 0954-5794 (ISSN-L)
- 1469-2198
- OpenAlex
- W2011044338
- Cited by
- 900
- References
- 0
- Citations by year
- 2026: 8 · 2025: 21 · 2024: 15 · 2023: 20 · 2022: 25 · 2021: 24 · 2020: 35 · 2019: 29 · 2018: 45 · 2017: 57 · 2016: 60 · 2015: 59 · 2014: 55 · 2013: 61 · 2012: 68
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Development and Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2k02mh000946-06)
- National Heart, Lung, and Blood Institute (R01 HC/CK47431)
- National Institute of Mental Health (MH60766, R03MH060766, MH-00946)
- National Center for Research Resources (M-01RR00042, M01RR000042)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenal insufficiency, cortisol, diurnal cortisol rhythm, hypothalamic-pituitary-adrenal axis, stress, childhood adversity, child development, salivary cortisol, developmental risk, trauma, chronic stress
- MeSH terms
- Affect, Child, Child Abuse, Psychology, Child, Circadian Rhythm, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Limbic System, Pituitary-Adrenal System, Risk Factors, Stress, Psychological, Mood Disorders
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