Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders

Tak, Lineke M.; Cleare, Anthony J.; Ormel, Johan; Manoharan, Andiappan; Kok, Iris C.; Wessely, Simon; Rosmalen, Judith

doi:10.1016/j.biopsycho.2011.02.002

Cited by 200 publications

(138 citation statements)

References 135 publications

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“…A systematic review of Van Cauwenbergh et al (2014) suggested a reduced cardiac response to a head-up tilt test in chronic fatigue patients in 7 of 8 studies. Taking the cortisol response to indicate hypothalamic-pituitary-adrenal (HPA) axis functioning, Tak et al (2011) only found evidence for lower cortisol levels in chronic fatigue patients and in females with fibromyalgia, but not in irritable bowel syndrome. A review by Powell et al (2013) could not establish hypocortisolism in chronic fatigue patients, but found evidence for an attenuation of the diurnal variability of the cortisol response.…”

Section: Authorsmentioning

confidence: 99%

Symptoms and the body: Taking the inferential leap

Bergh

Witthöft

Petersen

et al. 2017

Neuroscience & Biobehavioral Reviews

378

354

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a b s t r a c tThe relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.

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Section: Authorsmentioning

confidence: 99%

Symptoms and the body: Taking the inferential leap

Bergh

Witthöft

Petersen

et al. 2017

Neuroscience & Biobehavioral Reviews

378

354

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“…Esse eixo neuroendócrino participa da manutenção da homeostase corporal, mas sempre que o organismo se depara com um agente estressor de qualquer natureza (físico ou psicoemocional), o eixo HPA entra em hiperatividade o que resulta em níveis elevados de liberação de cortisol (CROFFORD et al, 2004). A resposta ao estresse deve ser rápida e durar de segundos a poucas horas, mas no caso de permanência do estímulo estressor por vários dias, meses ou anos, o eixo HPA entra em exaustão o que poderia explicar os baixos níveis de cortisol presentes em pacientes com FM (CARVALHO et al, 2008;TAK et al, 2011). O cortisol possui diversas ações, como a mobilização de energia estocada em depósitos corporais para ser utilizada pelas células e a ativação de osteoclastos.…”

Section: Fisiopatologiaunclassified

Fibromialgia: diagnóstico, fisiopatologia e tratamentos

et al. 2015

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RESUMOA fibromialgia (FM) é uma condição crônica, caracterizada pela presença de dor generalizada e outros sintomas como fadiga, distúrbios do sono e alterações cognitivas. Apesar de intensamente estudada, a fisiopatologia da FM ainda não foi totalmente esclarecida, o que prejudica seriamente a elaboração de condutas terapêuticas realmente eficazes. Dessa forma, a incidência da FM está crescendo e os gastos públicos e privados decorrentes desse fenômeno, também estão aumentando. Sem tratamento, os pacientes continuam a sofrer com a sintomatologia e se tornam cada vez mais desmotivados perante o seu quadro clínico. O objetivo deste estudo foi reunir e sintetizar parte da informação disponível sobre a FM, principalmente no que se refere aos critérios de diagnóstico, fisiopatologia, tratamentos farmacológicos e tratamentos não farmacológicos disponíveis. Para tanto, bancos de dados nacionais (Scielo e Bireme) e internacionais (Pubmed, Biomed, Medlinx e Pedro) foram consultados. Os dados deste estudo sugerem que a FM é uma condição clínica com etiologia multifatorial, que somente pode ser diagnosticada pelo exame clínico e que ainda não possui cura. Contudo, uma série de tratamentos encontra-se disponíveis, tanto farmacológicos como

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“…178 On the other hand, there are a number of pathologies characterized by decreased activity of the HPA axis, among them atypical/seasonal depression, chronic fatigue syndrome, postpartum blues or depression, systemic autoimmune diseases such as Sjogren's syndrome, and fibromyalgia. 167,[179][180][181] Some evidence demonstrates that these abnormalities are related to a "CRH deficient" phenotype characterized by blunted and delayed plasma ACTH responses, which are associated with small rather than exaggerated cortisol responses to CRH. 182,183 Interestingly, other pathogenetic mechanisms such as decreased glucocorticoid sensitivity and a re-activation of hypothalamic ACTH secretagogue peptides have recently been proposed as the pathophysiological mechanisms involved in fibromyalgia and postpartum blues, respectively.…”

Section: Chronic Stressmentioning

confidence: 99%

The central CLOCK system and the stress axis in health and disease

Kassi¹,

Chrousos²

2013

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are secreted in the portal system in a circadian and highly concordant pulsatile fashion. The activity of the HPA axis is in fact characterized not only by a classic circadian rhythm, but also by an ultradian pattern of discrete pulsatile release of glucocorticoids. Glucocorticoids are the final effectors of the HPA axis. These hormones are pleiotropic and exert their effects through their ubiquitously distributed intracellular glucocorticoid receptors alpha and beta (GRα and GRβ, respectively), both members of the nuclear receptor superfamily.2 The circadian release of ACTH/cortisol in their characteristic pulsatile manner appears to be controlled by one or more pace makers, whose exact location in the brain has not as yet been fully explored in humans. These diurnal variations are perturbed during daily activities like eating, sleeping, etc., while they are more greatly disrupted under stress conditions. Dysregulation of the HPA axis in basal conditions or in response to acute or chronic (including psychosocial) stress appear to be closely related to the onset and/or the progression of several diseases, such as metabolic syndrome, depression, and autoimmune diseases.Herein, we aim to review the current knowledge of the mechanisms that regulate ACTH and cortisol secretion under nonstressful conditions maintaining homeostasis as well as in stressful circumstances in an attempt to delineate the involvement of the 'stressresponse' component in disorders afflicting a large number of people.

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Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders

Cited by 200 publications

References 135 publications

Symptoms and the body: Taking the inferential leap

Symptoms and the body: Taking the inferential leap

Fibromialgia: diagnóstico, fisiopatologia e tratamentos

The central CLOCK system and the stress axis in health and disease

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