Open Access Highly Accessed Research article

Patterns of endogenous steroids in apathetic refugee children are compatible with long-term stress

Hans Peter Söndergaard1, Mark M Kushnir235, Bernice Aronsson4, Per Sandstedt4 and Jonas Bergquist25*

Author Affiliations

1 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

2 Department of Chemistry – Biomedical Center, Analytical Chemistry and SciLifeLab, Uppsala University, Uppsala, Sweden

3 ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, USA

4 Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden

5 Department of Pathology, University of Utah, Salt Lake City, USA

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BMC Research Notes 2012, 5:186  doi:10.1186/1756-0500-5-186

Published: 23 April 2012



During the last few years, a number of children of asylum applicants in Sweden developed an apathetic or unconscious state. The syndrome was perceived as new, and various explanations were advanced such as factitious disorder, intoxication, or stress. Considering a potential association between traumatic stress and regulation of steroids biosynthesis, this study explored whether changes in concentrations of endogenous steroids were associated with the above syndrome.


Eleven children were recruited in the study. Concentrations of steroids in blood samples were determined using high sensitivity liquid chromatography tandem mass spectrometry methods. Symptoms were assessed with a clinical rating scale developed for the study. Steroid concentrations were measured at the entry into study and after recovery; and concentrations were evaluated for the association with the symptoms in apathetic children.


Cortisol and cortisone concentrations at baseline were negatively associated with duration of the symptoms from entry into the study to clinical recovery. Higher concentrations of pregnanes (pregnenolone, 17-OH-pregnenolone, and dehydroepiandrosterone) were observed in the symptomatic state and the concentrations decreased after the recovery.


Pattern of low cortisol concentrations found in apathetic children is consistent with long-term stress. An increase of upstream steroid metabolites (pregnanes) was found to be associated with the symptomatic state.

Apathetic refugee children; Dissociative disorders; Cortisol; Steroids; Neurosteroids; Mass spectrometry