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CORTISOL LEVELS AND ANXIETY SEVERITY IN ADOLESCENTS WITH
NEUROCIRCULATORY DYSTONIA
Abdulkhakova R.M.
Andijan state medical institute Uzbekistan, Andijan
Abstract:
This study examines the relationship between serum cortisol levels and the severity of
anxiety in adolescents with neurocirculatory dystonia (NCD). The results demonstrate significantly
higher cortisol concentrations in the NCD group, accompanied by elevated scores on the State-Trait
Anxiety Inventory. These findings suggest a potential role of hypothalamic-pituitary-adrenal (HPA)
axis hyperactivity in the emotional and autonomic dysregulation observed in NCD.
Keywords:
neurocirculatory dystonia, cortisol, anxiety, adolescents, HPA axis.
Introduction
Neurocirculatory dystonia (NCD), a form of somatoform autonomic dysfunction, is frequently
diagnosed during adolescence—a developmental period marked by substantial hormonal and
psychological changes. The condition is characterized by a variety of autonomic symptoms,
including tachycardia, hypotension, dizziness, and emotional lability, with anxiety being a common
comorbidity [1, 2]. Recent findings have emphasized the contribution of the hypothalamic-pituitary-
adrenal (HPA) axis to stress-related disorders [3, 6]. Cortisol, the end product of this axis, is a key
biomarker of physiological stress and may play a role in the manifestation and severity of anxiety
symptoms in NCD [4, 7, 9]. This study aims to investigate the link between morning serum cortisol
levels and the degree of anxiety in adolescents with NCD.
Materials and Methods
Study Design and Participants. A cross-sectional study was conducted on 84 adolescents aged 14 to
17 years. Participants were divided into two groups: Group I (NCD group): 54 adolescents
diagnosed with NCD based on clinical criteria [1, 2].Group II (Control group): 30 age- and sex-
matched healthy individuals. Exclusion criteria included endocrine disorders, chronic inflammation,
or recent use of corticosteroids or psychotropic medications [4].Clinical and Psychological
Assessment. Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI),
which has been widely validated in both clinical and non-clinical populations [5]. Laboratory
Investigations.Morning cortisol was measured using chemiluminescent immunoassay methodology,
which provides high sensitivity for detecting HPA axis activity [6, 7].
Results
The positive correlation observed between cortisol levels and trait anxiety in adolescents with NCD
aligns with prior evidence of neuroendocrine dysregulation in affective disorders [8, 9].
To quantitatively assess the differences between adolescents with NCD and healthy controls,
cortisol levels and anxiety scores were measured. The results are presented in the table below:
Table 1. Cortisol levels and anxiety scores in adolescents with NCD and the control group.
Parameter
NCD Group (n=54) Control
Group
(n=30)
p-value
Morning
cortisol
(nmol/L)
490.2 ± 35.6
347.8 ± 28.4
< 0.01
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State Anxiety Score 48.3 ± 5.2
36.5 ± 4.9
< 0.01
Trait Anxiety Score 51.1 ± 6.1
38.9 ± 5.3
< 0.01
A significant positive correlation was observed between cortisol levels and trait anxiety scores in the
NCD group. No significant correlation was found in the control group.
Discussion.
The data suggest that adolescents with NCD have higher levels of serum cortisol and greater anxiety,
both in terms of state and trait dimensions. These findings are consistent with previous research
indicating dysregulation of the HPA axis in stress-related conditions [6, 8, 9]. The observed
correlation between cortisol levels and trait anxiety implies a chronic activation of the HPA axis.
This mechanism may underlie both emotional and somatic manifestations of NCD [3, 10]. Similar
patterns have been documented in adolescents with generalized anxiety disorder and other forms of
somatoform dysregulation [11, 12].From a developmental perspective, adolescence represents a
period of heightened vulnerability to stress due to neurohormonal transitions, which may exacerbate
HPA hyperreactivity and emotional instability [4, 7]. These findings support the need for
multidimensional treatment strategies that include both psychotherapeutic and neuroendocrine
components [3, 12].
Conclusion
Future longitudinal and interventional studies are warranted to further elucidate the causal
relationships and assess the effectiveness of treatments targeting HPA axis modulation in this
patient population. The findings of this study provide compelling evidence for the role of the
hypothalamic-pituitary-adrenal (HPA) axis in the development and maintenance of anxiety
symptoms in adolescents with neurocirculatory dystonia (NCD). The significantly elevated cortisol
levels observed in the NCD group, in conjunction with higher scores on the State-Trait Anxiety
Inventory, indicate a dysregulated stress response system [3, 4, 6]. These findings underscore the
clinical importance of incorporating neuroendocrine assessments into the evaluation and treatment
planning for adolescents with NCD [3, 11, 12]. The positive correlation between cortisol
concentration and trait anxiety suggests that adolescents with a sustained predisposition to anxiety
may experience chronic activation of the HPA axis. This may, in turn, exacerbate autonomic
dysfunction, contributing to the persistence and severity of NCD symptoms.
These findings underscore several important clinical implications:
1. Neuroendocrine screening (including cortisol levels) may be useful in the diagnostic and
prognostic assessment of adolescents with NCD and anxiety.
2. Integrative treatment approaches combining psychotherapeutic and neuroendocrine-targeted
strategies could enhance therapeutic outcomes.
3. Preventive strategies aimed at stress reduction in at-risk adolescents (e.g., mindfulness,
biofeedback, behavioral therapy) may reduce both anxiety symptoms and autonomic dysregulation.
References
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