Hypothalamic/pituitary/adrenal axis

Ritchie, JC and Nemeroff, CB (1991) Stress, the hypothalamic-pituitary-adrenal axis and depression. In Stress, Neuropeptides and Systemic Disease (Eds McCubbin, JA, Kaufmann, PG and Nemeroff, CB), Academic Press, London, pp. 181-197. 

Glucocorticoid doses of less than 7.5 mg/day of prednisone (or its equivalent) for fewer than 3 weeks generally would not be expected to lead to suppression of the hypothalamic-pituitary-adrenal axis. 

It is important to remember that adverse effects of topical corticosteroids may be systemic in nature and hypothalamic-pituitary-adrenal axis suppression can occur, especially when high-potency corticosteroids are used. Infants and small children may be more susceptible due to their increased skin sur-face body mass ratio.18 Topical corticosteroids may also cause striae, skin atrophy, acne, telangiectasias, and rosacea.2,10,18 Atrophy can result in thin, fragile, easily lacerated skin. Striae are caused by tearing of dermal connective tissue and are irreversible.18 Due to their significant adverse-effect profile, it has been recommended that no topical corticosteroid be used regularly for more than 4 weeks without review and reassessment.2... 

Topical corticosteroids Monitor for skin thinning, telangiec-tasias, and possible hypothalamic-pituitary-adrenal axis suppression. 

Roy, A., Pickar, D., Dejong, J., Karoum, F. Linnoila, M. (1998). Norepinephrine and its metabolites in cerebrospinal fluid, plasma and urine. Relationship to hypothalamic-pituitary-adrenal axis function in depression. Arch. Gen. Psychiatry, 45, 849-57. 

Stress Hormones 5.1.1. Hypothalamic-Pituitary-Adrenal Axis... 

Imura, H and Fukata, J., Endocrine-paracrine interaction in communication between the immune and endocrine systems. Activation of the hypothalamic-pituitary-adrenal axis in inflammation. Eur. J. Endocrinol. 130,32-37 (1994). 

R5. Reincke, M Allolio, B., Wurth, G and Winkelmann, W., The hypothalamic-pituitary-adrenal axis in critical illness Response to dexamethasone and corticotropin releasing hormone. J. Clin. Endocrinol. Metab. 77,151-156 (1993). 

RIO. Rivier, C., Chizzonite, R and Vale, W., In the mouse, the activation of the hypothalamic-pituitary-adrenal axis by a lipopolysaccharide (endotoxin) is mediated through interleukin-1. Endocrinology 125,2800-2805 (1989). 

However, nicotine also has been shown to stimulate the hypothalamic-pituitary-adrenal axis in rodents, leading to elevated plasma levels of adrenocorticotropic hormone and corticosterone (Andersson et al. 1983 Cam et al. 1979), which are known to exert a wake-promoting effect. However, studies in humans have shown that only intense smoking is able to activate the hypothalamic-pituitary-adrenal axis (Gilbert et al. 1992 Kirschbaum et al. 1992). Nicotine patches, in addition to their use in nicotine suppression and craving, have been used to explore the relationship between sleep and nicotine in human... 

The cortical-hypothalamic-pituitary-adrenal axis has been implicated in major depression 893... 

In depressed patients, cortical-hypothalamic-pituitary-adrenal axis hyperactivity can be explained by the hypersecretion of CRF, and secondary pituitary and adrenal gland hypertrophy. Impaired negative feedback at various CNS sites, including the hippocampus and pituitary are also likely to contribute. Downregulation of hippocampal mineralocorticoid receptors and expression is reported in depressed suicides [50]. In bipolar disorder, hyperactivity of the cortical-hypothalamic-pituitary-adrenal axis has been observed [51]. This increase in cortical-hypothalamic-pituitary-adrenal axis activity has also been observed in mixed mood states, mania and in depression in rapidcycling patients. Partial reversal of HPA overactivity is associated with treatment and recovery from depression. 

The most common cause of adrenal crisis is abrupt withdrawal of exogenous glucocorticoids in patients receiving chronic treatment that resulted in hypothalamic-pituitary-adrenal-axis suppression. 

Patients with PTSD have a hypersecretion of corticotropin-releasing factor but demonstrate subnormal levels of cortisol at the time of trauma and chronically. Dysregulation of the hypothalamic-pituitary-adrenal axis may be a risk factor for eventual development of PTSD. 

If treatment is continued for longer than 2 weeks, a tapering oral schedule should be employed to avoid hypothalamic-pituitary-adrenal axis suppression. 

Parsadaniantz, S. M. et al. Effects of the inhibition of cyclo-oxygenase 1 or 2 or 5-lipoxy-genase on the activation of the hypothalamic-pituitary-adrenal axis induced by interleukin-lbeta in the male Rat. J. Neuroendocrinol. 12, 766, 2000. 

Karrow, N. A., Activation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system during inflammation and altered programming of the neuroendocrine-immune axis... 

Rosecrans JA, Johnson JH, Tilson HA, et al. 1984. Hypothalamic-pituitary-adrenal axis (HPAA) function in adult Fischer-344 rats exposed during development to neurotoxic chemicals perinataly. Neurobehav Toxicol Teratol 6(4) 281-288. 

The exogenous administration of glucocorticoids can result in hypothalamic-pituitary-adrenal axis (HPA) suppression, which may subsequently lead to adrenal atrophy The degree of adrenal suppression is dependent on the dosage, duration, frequency, time, and route of administration of the specific glucocorticoids. At least one patient who received prednisone for neurological symptoms developed Cushing s syndrome. ... 

Marcilhac A, Dakine N, Bourhim N, Guillaume V, Grino M, Drieu K, Oliver C. (1998). Effect of chronic administration of Ginkgo biloba extract or ginkgolide on the hypothalamic-pituitary-adrenal axis in the rat. Life Sci. 62(25) 2329-40. 

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