Definition
The Hypothalamic-Pituitary-Adrenal (HPA) axis is the major neuroendocrine stress system in humans. Appropriate functioning of this highly dynamic multilevel system and its feedback mechanisms are assumed to modulate psycho-physiological adaptation to all major and minor challenges in life. In line with this, profound HPA axis alterations have been found in psychiatric disorders (most prominently affective disorders), in chronic medical disorders (e.g., cardiovascular disease), and in unexplained medical symptoms (e.g., chronic fatigue, Nater et al., 2008). Furthermore, it has been suggested that restoration of glucocorticoid receptor functioning and thereby improvement of HPA axis integrity might mediate treatment outcome in some disorders (such as depression) (Holsboer, 2000).
In order to assess the functional integrity of the HPA axis and its feedback mechanisms, standard pharmacological challenge tests...
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APA Task Force on Laboratory Tests in Psychiatry. (1987). The dexamethasone suppression test: An overview of its current status in psychiatry. The APA task force on laboratory tests in psychiatry. American Journal of Psychiatry, 144(10), 1253–1262.
Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., et al. (1981). A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility. Archives of General Psychiatry, 38(1), 15–22.
Cunnah, D., Jessop, D. S., Besser, G. M., & Rees, L. H. (1987). Measurement of circulating corticotrophin-releasing factor in man. Journal of Endocrinology, 113(1), 123–131.
Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130(3), 355–391.
Dickstein, G., Shechner, C., Nicholson, W. E., Rosner, I., Shen-Orr, Z., Adawi, F., et al. (1991). Adrenocorticotropin stimulation test: Effects of basal cortisol level, time of day, and suggested new sensitive low dose test. Journal of Clinical Endocrinology and Metabolism, 72(4), 773–778.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.
Heuser, I., Yassouridis, A., & Holsboer, F. (1994). The combined dexamethasone/CRH test: A refined laboratory test for psychiatric disorders. Journal of Psychiatric Research, 28(4), 341–356.
Holsboer, F. (2000). The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology, 23(5), 477–501.
Ising, M., Horstmann, S., Kloiber, S., Lucae, S., Binder, E. B., Kern, N., et al. (2007). Combined dexamethasone/corticotropin releasing hormone test predicts treatment response in major depression – a potential biomarker? Biological Psychiatry, 62(1), 47–54.
Ising, M., Kunzel, H. E., Binder, E. B., Nickel, T., Modell, S., & Holsboer, F. (2005). The combined dexamethasone/CRH test as a potential surrogate marker in depression. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29(6), 1085–1093.
Nater, U. M., Maloney, E., Boneva, R. S., Gurbaxani, B. M., Lin, J. M., Jones, J. F., et al. (2008). Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls. Journal of Clinical Endocrinology and Metabolism, 93(3), 703–709.
Yehuda, R. (2006). Advances in understanding neuroendocrine alterations in PTSD and their therapeutic implications. Annals of the New York Academy of Sciences, 1071, 137–166.
Young, E. A., Ribeiro, S. C., & Ye, W. (2007). Sex differences in ACTH pulsatility following metyrapone blockade in patients with major depression. Psychoneuroendocrinology, 32(5), 503–507.
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Ditzen, B., Nater, U.M., Heim, C. (2013). Pharmacological Stress Tests. In: Gellman, M.D., Turner, J.R. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1005-9_44
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DOI: https://doi.org/10.1007/978-1-4419-1005-9_44
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