HPA axis function and diurnal cortisol in post-traumatic stress disorder: A systematic review

Abstract

Background There is inconsistency in the literature regarding the nature of hypothalamic-pituitary-adrenal (HPA) axis functionality in post-traumatic stress disorder (PTSD). Purpose The review aimed to investigate HPA axis functionality via the diurnal profile of cortisol as it relates to PTSD. Methods The authors conducted a systematic review of the literature from June 2017 – March 2019 in accordance with The PRISMA Statement in the following four databases: PubMed, MEDLINE, ScienceDirect and PsycINFO with Full Text. The search strategy was limited to articles in English language, published in peer-reviewed journals within the last decade and human studies. Search terms included “post-traumatic stress disorder” OR “PTSD”, AND “hypothalamic pituitary adrenal axis” OR “HPA axis” AND “diurnal cortisol” OR “cortisol”. PTSD sufferers of all trauma types, genders and socioeconomic statuses were included provided there was a “healthy” control group and an inclusion of reporting on inter-group measurements of diurnal cortisol profiles as a portrayal of HPA axis functionality. Results A total of 10 studies met the criteria for inclusion in this review. The association between HPA axis functionality and PTSD was evaluated by the measurement of salivary and/or plasma cortisol concentrations. Only two studies demonstrated an association between PTSD and diurnal cortisol when compared with respective control groups while three studies found no associations. The remaining five studies found partial, mostly negative associations between PTSD and diurnal cortisol. Conclusion Despite some indications of an association between PTSD and dysregulated HPA axis functionality as demonstrated by diurnal cortisol output, the current review has revealed mixed findings. As such, a complete understanding of HPA axis dysregulation as it relates to PTSD remains unestablished. Given the findings, further investigation into the relationship between PTSD trauma-exposed and non-PTSD trauma-exposed individuals and diurnal cortisol is warranted.

Acute Physiological Responses Following a Bout of Vigorous Exercise in Military Soldiers and First Responders with PTSD: An Exploratory Pilot Study

“…However, salivary cortisol readings increased and decreased in a similar pattern in response to exercise for both groups. Considering this was contrary to our hypothesis, it is possible that cortisol reactivity to an acute exercise bout may not be sensitive enough to distinguish between PTSD and TEC [64].…”

Early Life Stress and Pediatric Posttraumatic Stress Disorder

“…Although HPA axis dysregulation has been recognized as a common pattern among adults as well as children diagnosed with PTSD, a definite conclusion regarding the longitudinal course of pediatric PTSD cannot be determined, given the divergence of the findings regarding stress hormone secretion. More specifically, low cortisol concentration is not a persistent finding among adults with PTSD, since several investigations have not demonstrated significant findings or presented circumstantial associations between PTSD and HPA axis dysregulation [110]. Moreover, altered HPA axis functionality observed in PTSD across lifespan may represent a pre-trauma risk factor for the disorder, indicating the presence of a vulnerable predisposition due to genetic and environmental risk factors, such as exposure to ELS during development, occurring prior to a traumatic event [110].…”

“…Moreover, altered HPA axis functionality observed in PTSD across lifespan may represent a pre-trauma risk factor for the disorder, indicating the presence of a vulnerable predisposition due to genetic and environmental risk factors, such as exposure to ELS during development, occurring prior to a traumatic event [110]. On the other hand, some researchers suggest that the alterations in physiological mechanisms found in PTSD may be the result of the disorder itself, or may even be attributed to trauma exposure rather than PTSD per se [110,111].…”

Gestational Factors throughout Fetal Neurodevelopment: The Serotonin Link

“…This, in turn, can lead to severe hormonal imbalances. Dysregulation of the HPA-axis is strongly implicated in the pathology of mood disorders, such as depression and anxiety disorders [74][75][76].…”