HPA axis function and diurnal cortisol in post-traumatic stress disorder: A systematic review.,Neurobiology of Stress

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HPA axis function and diurnal cortisol in post-traumatic stress disorder: A systematic review.
Neurobiology of Stress ( IF 4.3 ) Pub Date : 2019-06-04 , DOI: 10.1016/j.ynstr.2019.100180
Kathryn E Speer _{1,

2,

3} , Stuart Semple _{1,

2} , Nenad Naumovski _{3,

4,

5} , Nathan M D'Cunha _{3,

4} , Andrew J McKune _{1,

2,

3,

6}

Affiliation

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.

中文翻译：

创伤后应激障碍中的 HPA 轴功能和昼间皮质醇：系统评价。

背景

关于创伤后应激障碍 (PTSD) 中下丘脑-垂体-肾上腺 (HPA) 轴功能的性质，文献中存在不一致的地方。

目的

该综述旨在通过皮质醇的昼夜变化来研究 HPA 轴的功能，因为它与 PTSD 相关。

方法

作者根据 PRISMA 声明，对以下四个数据库中 2017 年 6 月至 2019 年 3 月的文献进行了系统回顾：PubMed、MEDLINE、ScienceDirect 和 PsycINFO with Full Text。搜索策略仅限于过去十年内在同行评审期刊上发表的英文文章和人类研究。搜索词包括“创伤后应激障碍”或“PTSD”，以及“下丘脑垂体肾上腺轴”或“HPA 轴”和“昼间皮质醇”或“皮质醇”。所有创伤类型、性别和社会经济地位的 PTSD 患者都被包括在内，前提是有一个“健康”对照组，并包括对昼间皮质醇分布的组间测量报告作为 HPA 轴功能的描述。