https://orcid.org/0000-0001-9672-2603
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ABSTRACT
It has been hypothesized that the occurrence of central serous chorioretinopathy (CSC) might be associated with stress. Therefore, our purpose was to investigate the diurnal trajectories of salivary cortisol and α-amylase (α-Amy) – markers of hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system activity, respectively – and psychological profiles in idiopathic acute CSC. This cross-sectional observational case-control study, which included self-reported psychometric questionnaires, was formally approved by the Ethics Committee. Written informed consent was obtained from all participants. Home diurnal saliva collection was scheduled at several timepoints: at awakening, 30 and 60 min later, and at approximately 13:00 h and 20:00 h. Twenty consecutive male subjects with first-episode CSC attending the outpatient clinic of the Retina Medical Service at the Bietti Foundation were enrolled in the study. Twenty age-matched subjects were recruited as controls. After their initial enrollment, 3 subjects per group were excluded. The production of cortisol and α-Amy and the scores on the negative subscale of the Positive/Negative Affect Schedule, the Daily Hassles and Stress Scale and the Beck Depression Inventory were higher in the CSC group than in the control group. To estimate the diurnal trends in the production of salivary cortisol and α-Amy, an equation was derived for each group of the study population. The equations describing the interpolated regression lines gave salivary cortisol and salivary α-Amy slopes that were determined to be significantly different by Student’s t-test (cortisol: t = 3.533, p < .001; α-Amy: t = 2.382, p = .018). Furthermore, the area under the curve with respect to the ground (AUCG) was calculated to summarize repeated salivary biomarker measurements from 07:00 h to 08:00 h for assessment of the cortisol awakening response (CAR) and the α-Amy awakening response (AR). The diurnal cortisol AUCG and diurnal α-Amy AUCG were calculated from 07:00 h to 20:00 h. The CAR AUCG values of the CSC patients were significantly higher than those of the controls. No differences between the two groups were detected for the α-Amy AR AUCG. The present study adds novel information to the growing body of data suggesting that abnormal diurnal activity of the HPA axis and the SAM system is associated with CSC in susceptible individuals, providing ophthalmologists with a new chronobiological approach for these patients.
Acknowledgments
The funders had no role in study design, data collection or analysis, decision to publish, or preparation of the manuscript.
Competing interests
The authors declare that they have no proprietary interest in the materials used in this study. Dr. Scarinci, Dr. Patacchioli, Dr. Palmery, Dr. Pasquali, Dr. Costanzo, and Dr. Cristina Mihaela Ghiciuc have no conflicts of interest to declare. Dr. Parravano reports personal fees from Allergan, personal fees from Bayer, and personal fees from Novartis outside the submitted work.
Ethics approval and consent to participate
The study was approved by the Ethics Committee for Lazio, Italy (protocol no. 4327/April 18th, 2018). Signed informed consent was obtained from the patients.
Patient consent for publication
Not applicable.
Role of the funder/sponsor
The supporting organizations had no role in the design or conduction of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.