It is debated as to whether major depressive disorder (MDD) and the burnout syndrome represent different aspects of the same syndrome or whether they reflect separate entities. A dysregulation of the hypothalamus-pituitary-adrenal-axis has been related to both conditions separately. Dissecting the pathophysiology of the conditions and describing differences and similarities with regard to stress physiological systems might further clarify whether underlying etiological models of these syndromes differ. A systematic literature search including MDD and the burnout syndrome and peripheral cortisol measures was performed and resulted in 190 studies for inclusion in the qualitative synthesis. For MDD, findings suggest a general state of hypercortisolism and glucocorticoid resistance reflected by increased basal cortisol levels, reduced reactivity to psychosocial stress and a reduced cortisol suppression in pharmacological challenge tests. For the burnout syndrome, two central factors limit further conclusions: i) there is not a sufficient amount of studies examining the burnout syndrome and different cortisol secretion patterns to provide an evidence base, ii) the burnout syndrome is assessed heterogeneously reflecting imprecision of the measured constructs. Large prospective cohort studies examining both conditions in parallel rigorously controlling for confounders are required to further elucidate the differences and similarities of the HPA axis in MDD and the burnout syndrome.

中文翻译：

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在重度抑郁症和倦怠综合症中检查外周基础和反应性皮质醇水平：系统评价。

关于重度抑郁症（MDD）和倦怠综合症是否代表同一综合症的不同方面或它们是否反映不同的实体，存在争议。下丘脑-垂体-肾上腺轴失调已分别与这两种情况有关。解剖条件的病理生理学并描述应激生理系统的差异和相似之处可能会进一步阐明这些综合征的潜在病因模型是否不同。进行了系统的文献检索，包括MDD和倦怠综合征以及周围皮质醇的测定结果，并进行了190项研究以纳入定性合成。对于MDD，研究结果表明基本皮质醇水平升高反映出皮质醇过多和糖皮质激素抵抗的总体状态，在药理学挑战试验中降低了对社会心理压力的反应性并降低了皮质醇抑制。对于倦怠综合征，有两个中心因素限制了进一步的结论：i）缺乏足够的研究来研究倦怠综合征和不同皮质醇分泌模式以提供依据，ii）倦怠综合征的评估是异质性的，反映了所测量的不准确性结构体。为了进一步阐明MDD和倦怠综合症中HPA轴的差异和相似性，需要进行大规模前瞻性队列研究，同时严格控制混杂因素，同时检查这两种情况。i）缺乏足够的研究来研究倦怠综合征和不同皮质醇分泌模式，以提供依据。ii）倦怠综合征的评估是异质性的，反映了所测结构的不精确性。为了进一步阐明MDD和倦怠综合症中HPA轴的差异和相似性，需要进行大规模前瞻性队列研究，同时严格控制混杂因素，同时检查这两种情况。i）缺乏足够的研究来研究倦怠综合征和不同皮质醇分泌模式，以提供依据。ii）倦怠综合征的评估是异质性的，反映了所测结构的不精确性。为了进一步阐明MDD和倦怠综合症中HPA轴的差异和相似性，需要进行大规模前瞻性队列研究，同时严格控制混杂因素，同时检查这两种情况。