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Letters to the Editor |

Low Salivary Cortisol Levels and Aggressive Behavior—Reply

Keith McBurnett, PhD
Arch Gen Psychiatry. 2001;58(5):514-515. doi:.
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We recently reported that longitudinal measures of cortisol and aggression were inversely correlated and that low cortisol levels were correlated with early onset of aggression.1 We hesitated to speculate on mechanisms underlying these associations because of the bidirectional possibilities and the many degrees of freedom within the hypothalamic-pituitary-adrenal (HPA) axis.

Herzog and colleagues report that a 13-year-old boy with severe anxiety and aggression had low to normal cortisol levels but high levels of the adrenal androgen DHEA-S (dehydroepiandrosterone sulfate) along with 21-hydroxylase enzyme deficiency. Treatment that lowered DHEA-S and other excitatory neurohormones while raising inhibitory neurohormones improved behavioral symptoms. The case is intriguing because the endocrine profile took the opposite direction from that reported in eating disorders.2 Second, treatment that returned endocrine concentrations to normal ranges reversed the behavioral disturbance. The curvilinear dose-response relationship highlights the importance of titrating dose to hormonal and behavioral criteria in this case.


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