Attenuated Neuroendocrine Response to Hypoglycemic Stress in Patients with Panic Disorder

Abstract

Background/Aims: There is a lack of information on the effects of metabolic stress exposure on hormone release in patients with panic disorder. The aim of this study was to test the hypothesis that neuroendocrine activation during hypoglycemic stress is altered in panic disorder patients compared to healthy subjects. Methods: Hormone responses to an intravenous bolus of insulin (0.1 IU/kg) were evaluated in both fully remitted, medication-free panic disorder patients and healthy controls (n = 9/group). Blood samples for determination of cortisol, growth hormone, prolactin, adrenaline and noradrenaline concentrations were obtained at rest and over a 90-min period after insulin injection. Results: In patients with panic disorder, basal prestress hormone levels were comparable to those in healthy subjects with the exception of plasma adrenaline, which was higher in panic disorder patients compared to controls. The degree of hypoglycemia induced by insulin administration was similar in patients and healthy subjects. Hypoglycemia-induced increases in growth hormone, prolactin and cortisol concentrations were significantly attenuated in panic disorder patients compared to healthy individuals. No differences between patients and controls were observed in adrenalin release induced by hypoglycemia. Conclusions: The present data demonstrate that somatotropic, lactotropic and corticotropic activation during hypoglycemic stress is blunted in patients with panic disorder. It is suggested that in contrast to the effects of relatively mild stress conditions used in other studies published in the literature, intensive stressors inducing a broad spectrum of hormonal changes fail to provoke an adequate neuroendocrine response in patients with panic disorder.

The Adrenal Gland Volume Measurements in Manifestation of the Metabolic Status in Type-2 Diabetes Mellitus Patients

“…However, not only exaggerated but also inadequate HPA activation in response to demanding stimuli may have negative consequences. Consistently, patients with an anxiety disorder showed attenuated response to hypoglycemia compared to healthy controls [ 16 ].…”

Hydrocortisone Dose Influences Pain, Depressive Symptoms and Perceived Health in Adrenal Insufficiency: A Randomized Controlled Trial

“…Lower plasma cortisol levels are found in several stress-associated neuropsychiatric disorders, e.g. posttraumatic stress disorder, panic disorders and chronic pain and fatigue syndromes [36,37,38]. This resembles the findings in our study, with more complaints of pain and fatigue being reported by patients receiving the lower dose of HC, an intriguing finding which points to a direct role for HC rather than to other hormones of the hypothalamic-pituitary-adrenal axis because feedback regulation is absent in our patients due to their pituitary disease.…”

Increased Anxiety Induced by Listening to Unpleasant Music during Stress Exposure Is Associated with Reduced Blood Pressure and ACTH Responses in Healthy Men

“…Increased trait anxiety as a personal characteristic is likely to have a sustained influence on the behavior and strategies of stress coping. Since patients with certain anxiety disorders also exhibit similar patterns of neuroendocrine changes during stress [4,5], it may be suggested that the reduced hormonal and cardiovascular response is inadequate. The present findings demonstrate that even an acute increase in state anxiety is enough to modulate physiological reactivity under stress conditions.…”

“…Accordingly, reduced activation of the hypothalamic-pituitary-adrenocortical axis associated with high trait anxiety has been confirmed in animal studies [3]. Moreover, this phenomenon has been observed in patients with panic disorder [4,5]. …”