下丘脑-垂体-肾上腺轴
慢性疲劳综合征
内分泌系统
内科学
医学
压力源
促肾上腺皮质激素
社会心理的
内分泌学
氢化可的松
胰岛素耐受试验
特里尔社会压力测试
病因学
慢性应激
心理学
战斗或逃跑反应
激素
临床心理学
胰岛素
精神科
胰岛素抵抗
化学
基因
生物化学
胰岛素敏感性
作者
Jens Gaab,Dominik Hüster,Renate Peisen,Veronika Engert,Vera Heitz,Tanja Schad,T. H. Schürmeyer,Ulrike Ehlert
标识
DOI:10.1097/01.psy.0000038937.67401.61
摘要
Subtle alterations of the hypothalamic-pituitary-adrenal (HPA) axis in chronic fatigue syndrome (CFS) have been proposed as a shared pathway linking numerous etiological and perpetuating processes with symptoms and observed physiological abnormalities. Because the HPA axis is involved in the adaptive responses to stress and CFS patients experience a worsening of symptoms after physical and psychological stress, we tested HPA axis functioning with three centrally acting stress tests.We used two procedures mimicking real-life stressors and compared them with a standardized pharmacological neuroendocrine challenge test. CFS patients were compared with healthy control subjects regarding their cardiovascular and endocrine reactivity in a psychosocial stress test and a standardized exercise test, and their endocrine response in the insulin tolerance test (ITT).Controlling for possible confounding variables, we found significantly lower ACTH response levels in the psychosocial stress test and the exercise test, and significantly lower ACTH responses in the ITT, with no differences in plasma total cortisol responses. Also, salivary-free cortisol responses did not differ between the groups in the psychosocial stress test and the exercise test but were significantly higher for the CFS patients in the ITT. In all tests CFS patients had significantly reduced baseline ACTH levels.These results suggest that CFS patients are capable of mounting a sufficient cortisol response under different types of stress but that on a central level subtle dysregulations of the HPA axis exist.
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