Pharmacological Stress Tests
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...
References and Readings
- 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.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar
- 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.PubMedCrossRefGoogle Scholar