Beyond Cortisol: Developmentally Moderated Endocrine Dysregulation, Hormonal Coupling, and Metabolic Shifts in Adolescent Psychological Stress
DOI :
https://doi.org/10.62255/mjhp.v4iSuppl%201.313Abstract
Background: Adolescence concentrates internalizing disorder emergence alongside pubertal reorganization of stress-sensitive endocrine systems. The prevailing view of stress as uniformly elevating cortisol fails to explain heterogeneous findings across diverse adolescent samples.
Objective: To synthesize evidence linking psychological stress to endocrine outcomes in adolescence and determine whether "hormonal imbalance" reflects fixed excess/deficit or developmentally moderated dysregulation and cross-axis uncoupling.
Methods: A critical evidence synthesis of 66 records (observational, longitudinal, experimental, limited intervention) prioritized 2015–2025 cortisol research and 2010–2025 pubertal work. Findings were triangulated by chronicity, pubertal stage, sex, assay modality, and confounder control, graded using an ordinal confidence rubric. Meta-analytic pooling was precluded by heterogeneity.
Results: The most reproducible signal of adolescent stress is altered cortisol patterning (elevated evening levels, flatter diurnal slope), with recent-onset symptoms driving hyperreactivity and chronic symptoms causing blunted responses. Additionally, early adversity attenuates normal cortisol-DHEA coupling, while thyroid and metabolic alterations remain plausible but heavily confounded by sleep, adiposity, and pubertal maturation.
Conclusion: Adolescent stress-associated endocrine imbalance is best conceptualized as non-linear, puberty- and sex-modulated loss of endocrine coordination. Clinical assessment should prioritize chronicity, pubertal staging, sleep, adiposity, and repeated diurnal sampling over single biomarker cutoffs
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