Salivary cortisol in panic: are males more vulnerable?

Area of Science:

• Neuroscience
• Endocrinology
• Psychiatry

Background:

• The physiological mechanisms underlying panic attacks (PAs) remain debated, particularly their relationship with fear and the activation of the hypothalamic-pituitary-adrenal (HPA) axis.
• Existing research on HPA-axis activity during laboratory-induced PAs has yielded inconclusive results.

Purpose of the Study:

• To investigate HPA-axis activity by measuring cortisol levels in patients with panic disorder (PD) compared to healthy volunteers following a 35% CO2 challenge.
• To explore potential gender-specific differences in HPA-axis response during induced panic.

Main Methods:

• Salivary cortisol levels were measured in 23 PD patients and 20 healthy volunteers before and after a 35% CO2 inhalation challenge.
• Anxiety levels were assessed, and potential gender effects on cortisol response were analyzed.

Main Results:

• The 35% CO2 challenge significantly increased anxiety in participants but did not elicit a significant cortisol increase.
• No significant difference in cortisol levels was observed between PD patients and controls post-challenge, despite greater anxiety increases in patients.
• Male PD patients exhibited higher cortisol values compared to other groups.

Conclusions:

• The findings suggest that PAs may not be associated with substantial HPA-axis activation, challenging the classical flight response model.
• Aberrant cortisol secretion in male PD patients warrants further investigation.
• Future research should explore potential sex differences in the HPA-axis mechanisms underlying panic disorder.