Hypothalamic-pituitary-adrenal axis function following a 35% CO2 inhalation in healthy volunteers

Rationale: The hypothalamic-pituitary-adrenal axis (HPA axis) is a central component of the brain's neuroendocrine response to stress. The extent of increase in cortisol secretion, provides an index of the HPA axis activity, and in this way, objectively reflects perceived stress. In healthy subjects, the 35% CO2 inhalation does hardly induce stress, as expressed in anxiety. However, inconsistent results have been found in studies investigating the cortisol response following CO2 inhalation. Clarity has to be reached about the normal reaction to this challenge, especially because this model is still a very valuable method to study central aspects of panic. Objectives: The present study aimed to test the hypothesis that a single breath of 35% CO2 would not induce cortisol release in healthy volunteers. Methods: In the current study, 20 healthy subjects underwent both a 35% CO2 and a placebo inhalation in a randomised, single blind fashion. Cortisol levels were determined in saliva samples, taken at regular intervals. Results: No differences were found between the CO2 and the placebo condition. In both conditions a significant time effect was found, which can be subscribed to normal variation in the circadian rhythm. Furthermore, only modest subjective anxiety scores were found in the CO2 condition. Conclusions: These results provide biological evidence for the hypothesis that healthy subjects are not affected by the 35% CO2 challenge in a clinically significant way. Characteristic, PD patients react much stronger to the inhalation. Thus, in addition to psychological parameters, healthy subjects also constitute an ideal comparison group with regard to endocrinological parameters. (C) 2003 Elsevier Inc. All rights reserved.