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Altered responsiveness of the hypothalamus-pituitary-adrenal axis and the sympathetic adrenomedullary system to stress in patients with atopic dermatitis.
J Clin Endocrinol Metab. 2002 Sep; 87(9):4245-51.JC

Abstract

A growing number of animal data strongly suggest that a hyporeactive hypothalamus-pituitary adrenal (HPA) axis may be pathologically significant by increasing the susceptibility to chronic inflammation. Following this line of evidence, the specific goal of the present study was to investigate the HPA axis in patients with atopic dermatitis (AD), a chronic allergic inflammatory disease. In addition, the sympathetic adrenomedullary (SAM) system as a second potent immunoregulatory and anti-inflammatory stress-response system has been examined. AD patients (n = 36) and nonatopic control subjects (n = 37) were exposed to a standardized laboratory stressor consisting of a free speech and mental arithmetic task in front of an audience. Cortisol, ACTH, and catecholamine concentrations were assessed before and after the stressor. To investigate feedback sensitivity of the HPA axis, a low dose (0.5 mg) dexamethasone suppression test was also performed. AD patients showed significantly attenuated cortisol and ACTH responses to the stressor, whereas catecholamine levels were significantly elevated in atopic patients. No difference between the experimental groups was found in basal cortisol and ACTH concentrations, whereas basal catecholamine levels were significantly elevated. Analysis of cortisol levels after dexamethasone treatment suggested an intact feedback sensitivity in AD sufferers at the pituitary level. The present findings suggest that patients with AD demonstrate a blunted HPA axis responsiveness with a concurrent overreactivity of the SAM system to psychosocial stress. Considering the important immunoregulatory role of the HPA axis and the SAM system, especially under stressful conditions, an aberrant responsiveness of these neuroendocrine systems may increase the susceptibility to (allergic) inflammation and may be one psychobiological mechanism of stress-related aggravation of the disease.

Authors+Show Affiliations

Center for Psychobiological and Psychosomatic Research, University of Trier, 54286 Trier, Germany. buske@uni-trier.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12213879

Citation

Buske-Kirschbaum, Angelika, et al. "Altered Responsiveness of the Hypothalamus-pituitary-adrenal Axis and the Sympathetic Adrenomedullary System to Stress in Patients With Atopic Dermatitis." The Journal of Clinical Endocrinology and Metabolism, vol. 87, no. 9, 2002, pp. 4245-51.
Buske-Kirschbaum A, Geiben A, Höllig H, et al. Altered responsiveness of the hypothalamus-pituitary-adrenal axis and the sympathetic adrenomedullary system to stress in patients with atopic dermatitis. J Clin Endocrinol Metab. 2002;87(9):4245-51.
Buske-Kirschbaum, A., Geiben, A., Höllig, H., Morschhäuser, E., & Hellhammer, D. (2002). Altered responsiveness of the hypothalamus-pituitary-adrenal axis and the sympathetic adrenomedullary system to stress in patients with atopic dermatitis. The Journal of Clinical Endocrinology and Metabolism, 87(9), 4245-51.
Buske-Kirschbaum A, et al. Altered Responsiveness of the Hypothalamus-pituitary-adrenal Axis and the Sympathetic Adrenomedullary System to Stress in Patients With Atopic Dermatitis. J Clin Endocrinol Metab. 2002;87(9):4245-51. PubMed PMID: 12213879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Altered responsiveness of the hypothalamus-pituitary-adrenal axis and the sympathetic adrenomedullary system to stress in patients with atopic dermatitis. AU - Buske-Kirschbaum,Angelika, AU - Geiben,Andrea, AU - Höllig,Heike, AU - Morschhäuser,Ellen, AU - Hellhammer,Dirk, PY - 2002/9/6/pubmed PY - 2002/10/4/medline PY - 2002/9/6/entrez SP - 4245 EP - 51 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 87 IS - 9 N2 - A growing number of animal data strongly suggest that a hyporeactive hypothalamus-pituitary adrenal (HPA) axis may be pathologically significant by increasing the susceptibility to chronic inflammation. Following this line of evidence, the specific goal of the present study was to investigate the HPA axis in patients with atopic dermatitis (AD), a chronic allergic inflammatory disease. In addition, the sympathetic adrenomedullary (SAM) system as a second potent immunoregulatory and anti-inflammatory stress-response system has been examined. AD patients (n = 36) and nonatopic control subjects (n = 37) were exposed to a standardized laboratory stressor consisting of a free speech and mental arithmetic task in front of an audience. Cortisol, ACTH, and catecholamine concentrations were assessed before and after the stressor. To investigate feedback sensitivity of the HPA axis, a low dose (0.5 mg) dexamethasone suppression test was also performed. AD patients showed significantly attenuated cortisol and ACTH responses to the stressor, whereas catecholamine levels were significantly elevated in atopic patients. No difference between the experimental groups was found in basal cortisol and ACTH concentrations, whereas basal catecholamine levels were significantly elevated. Analysis of cortisol levels after dexamethasone treatment suggested an intact feedback sensitivity in AD sufferers at the pituitary level. The present findings suggest that patients with AD demonstrate a blunted HPA axis responsiveness with a concurrent overreactivity of the SAM system to psychosocial stress. Considering the important immunoregulatory role of the HPA axis and the SAM system, especially under stressful conditions, an aberrant responsiveness of these neuroendocrine systems may increase the susceptibility to (allergic) inflammation and may be one psychobiological mechanism of stress-related aggravation of the disease. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/12213879/Altered_responsiveness_of_the_hypothalamus_pituitary_adrenal_axis_and_the_sympathetic_adrenomedullary_system_to_stress_in_patients_with_atopic_dermatitis_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2001-010872 DB - PRIME DP - Unbound Medicine ER -