Altered tonic and phasic cortisol secretion following unilateral stroke

Lueken, Ulrike; Leisse, Markus; Mattes, Klaus; Naumann, Doris; Wittling, Werner; Schweiger, Elisabeth

doi:10.1016/j.psyneuen.2008.10.002

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Volume 34, Issue 3 , Pages 402-412, April 2009

Altered tonic and phasic cortisol secretion following unilateral stroke

Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, D-01187 Dresden, Germany
- Center for Neuropsychological Research, University of Trier, Johanniterufer 15, D-54290 Trier, Germany
- Corresponding author at: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, D-01187 Dresden, Germany. Tel.: +49 351 463 38599; fax: +49 351 463 36984.
Markus Leisse
- Median Reha-Center Bernkastel-Kues, Klinik Burg Landshut, Kueser Plateau, D-54470 Bernkastel-Kues, Germany
- Tel.: +49 6531 924 732; fax: +49 6531 924 881.
Klaus Mattes
- Median Reha-Center Bernkastel-Kues, Klinik Burg Landshut, Kueser Plateau, D-54470 Bernkastel-Kues, Germany
- Tel.: +49 6531 924 731; fax: +49 6531 924 881.
Doris Naumann
- Median Reha-Center Bernkastel-Kues, Klinik Burg Landshut, Kueser Plateau, D-54470 Bernkastel-Kues, Germany
- Tel.: +49 6531 924 763; fax: +49 6531 924 881.
Werner Wittling
- Center for Neuropsychological Research, University of Trier, Johanniterufer 15, D-54290 Trier, Germany
- Tel.: +49 651 201 3751; fax: +49 651 201 3766.
Elisabeth Schweiger
- Center for Neuropsychological Research, University of Trier, Johanniterufer 15, D-54290 Trier, Germany
- Tel.: +49 651 201 3752; fax: +49 651 201 3766.

Received 14 March 2008; received in revised form 25 September 2008; accepted 1 October 2008.

Summary

Evidence is accumulating that cerebral laterality appears to be an important feature in the regulation of the stress response with the right hemisphere being closely linked to stress-regulatory systems, including the hypothalamic–pituitary–adrenal (HPA) axis. Although some animal and human data support this hypothesis, studies on brain damaged patients yet failed to substantiate laterality effects on cortisol secretion. The aim of this study was to examine whether unilateral stroke differentially affects tonic and phasic response characteristics of the HPA axis, and to evaluate the impact of intrahemispheric lesion location. Basal morning cortisol levels and phasic responses towards a mentally challenging task were examined in 32 stroke patients with left-sided (LH; n=18) or right-sided (RH; n=14) infarctions and 30 healthy controls matched for age and gender. Only LH, but not RH patients displayed increased morning cortisol levels when compared to controls. In contrast, phasic reactions were blunted in the combined patient group with RH patients showing the most distinct decline. More anterior located lesions were associated with reduced phasic, but not tonic cortisol measures. This relationship appeared to be particularly pronounced in RH patients. Results support the conclusion that the central regulation of cortisol secretion is under excitatory control of the right hemisphere and can be interpreted within a framework of asymmetrical regulation of the stress response. Left- and right-sided strokes may differentially affect response patterns of the HPA axis, a stress-regulatory system that is associated with effective protection against disease and external challenges.