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Tijdschrift voor Psychiatrie 43 (2001) 9, 631 - 638

Review article

Alterations in the hypothalamic-pituitary-adrenal axis in posttraumatic stress disorder

A. Allahbakhshi, R.J.P. Rijnders

background While enduring a traumatic experience an organism will try to mobilize defense mechanisms in order to deal with the extreme stress. The hypothalamic-pituitary-adrenal axis (hpa-axis) is known to be one of the most important systems involved. In the last decades much research was done regarding these mechanisms in groups of traumatized people respectively with and without a posttraumatic stress disorder (ptsd).
aim To review the results of research on the hpa-axis alterations in traumatized persons.
method Reviewing literature by means of Medline search using the keywords cortisol, hypothalamic- pituitary-adrenal axis and posttraumatic stress disorder; also using relevant crossreferences.
results and conclusion The dysregulation of the hpa-axis appears to be crucial in the ptsd. Contrary to patients with a depressive disorder, ptsd subjects exhibit a lower mean baseline 24-hour urinary cortisol excretion. They also have a hypersuppression following the dexamethasone suppression test. Traumatic events appear to be related to an elevated number of glucocorticoid receptors. However, only traumatized subjects with PTSD show a hypersensitivity of the hpa-axis.

keywords cortisol, dexamethasone suppression test, hypothalamic-pituitaryadrenal axis, posttraumatic stress disorder