Pharmacopsychiatry 2003; 36 - 40
DOI: 10.1055/s-2003-825291

Electronic monitoring of the cortisol daytime profiles during the process of alcohol withdrawal

J Cordes 1, L Kostorz 1, U Henning 1, T Schillen 1, W Burtscheidt 1, C Kirschbaum 2, A Klimke 1
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie der Heinrich-Heine-Universität; Duesseldorf
  • 2Institut für Experimentelle Psychologie II, Abteilung Psychoendokrinologie/Psychoimmunologie der Heinrich-Heine-Universität, Duesseldorf


Alcohol intoxication activates the HPA axis and results in elevated glucocorticoid levels. There is a marked activation of the HPA associated with the ethanol withdrawal syndrome (1).


Objective compliance was measured by using an electronic monitoring system (2). 10 male patients with an alcohol illness were instructed to collect six samples of saliva throughout the day. The profile was measured on the second, third and tenth day during a stationary withdrawal.


The available evaluations show a clear increase of the cortisol daytime profile to 3 PM after awakening. An equivalent low concentration of cortisol is found between 3 PM and 10 PM in the saliva. The maximum rise lies between 30 minutes after awakening and 11 AM. During the process of the withdrawal a flattening of the daily profile shows up. After 10 days a normalization of the profile occurred or it shows an increased corticol profile in the saliva.


The investigation confirms the connection between the ethanol withdrawal syndrome and an activation of the HPA axis. During a vulnerable phase in the morning the HPA activity is affected by the alcohol withdrawal. After ten days of a stationary alcohol withdrawal the different types of reaction may have clinical implications.


1 Risher-Flowers D, Adinoff B, Ravitz B, Bone GH, Martin PR, Nutt D, Linnoila M (1988) Circadian rhythms of cortisol during alcohol withdrawal. Adv Alcohol Subst Abuse 7 (3–4): 37–41

2 Kudielka BM, Broderick JE, Kirschbaum C (2003) Compliance with saliva sampling protocols: Electronic monitoring reveals invalid cortisol daytime profiles in noncompliant subjects. Psychosomatic Medicine 65:313–319