The main goal of this study was to evaluate whether a unilateral brain lesion in a human population is associated with a modification of the circadian cortisol secretion profile, and/or patient's emotional state. The second goal of this study was to assess whether there would be differences in both the pattern of cortisol secretion and emotional state in brain-damaged patients as a function of side of lesion, and localization (anterior vs posterior) of lesion. Eight patients with a left cortical lesion, six patients with a right cortical lesion, four patients with basal ganglia lesions (2 left and 2 right) and ten healthy volunteers were evaluated daily on measures of salivary cortisol levels and subjective feelings of joy and sadness at 0700, 1200, 1600 and 1900 hours over a 15-day period. Patients with cortical brain lesions presented higher cortisol levels and higher scores of sadness at the time of the morning peak (7:00 am), when compared to healthy volunteers and patients with basal ganglia lesions. Laterality of the lesion was not related to cortisol secretion, but frontal damage (anterior lesion) was associated with higher cortisol levels at the time of the morning peak (7:00 am) when compared to more posterior damage. There was no significant correlation between basal circulating levels of cortisol and emotional states in patients and healthy subjects. The results of this study suggest that hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with unilateral injury particularly in frontal areas. These results, obtained in a human population, go along with recent animal studies reporting an implication of frontal regions in HPA activity.
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