In their article "Low Salivary Cortisol and Persistent Aggression in Boys Referred for Disruptive Behavior," McBurnett et al1 report a relationship between low (ie, below the group median) salivary cortisol levels and aggressive behavior in boys. They conclude that low hypothalamic-pituitary-adrenal axis activity may be a correlate of severe and persistent aggression in male children and adolescents. Their interesting finding raises another consideration. Is it possible that some of these boys could have had a readily treatable endocrine disorder, namely a form of late-onset congenital adrenal hyperplasia with disturbed cortisol production as a result of inherited enzyme deficiency, resulting in abnormally high serum levels of androgenic intermediaries of cortisol synthesis that might contribute to the development of aggressive behavior? A case in point follows.
Herzog AG, Edelheit PB, Jacobs AR. Low Salivary Cortisol Levels and Aggressive Behavior. Arch Gen Psychiatry. 2001;58(5):513-514. doi: