Hypothalamic-Pituitary-Adrenal axis

What is HPA?

The biological response to stress is mediated through the Hypothalamic-Pituitary-Adrenal (HPA) axis and the sympathetic nervous system. Cortisol and the steroid hormone dehydroepiandrosterone (DHEA) and its sulfate form DHEA-S are important for elucidating the role of HPA dysfunctions in PTSD. Stress is a threat to the body’s ability to regulate internal processes following exposure to an adverse event. People adapt physiologically and behaviourally in response to stress to re-establish internal balance. Altered HPA axis activity can be detrimental to physical and psychological health.

What is the evidence for HPA dysfunction in people with PTSD?

Moderate to high quality evidence found small decreases in morning and 24-hour cortisol levels in people with PTSD compared to controls. The effect was larger in studies with non-trauma-exposed controls than in studies with trauma-exposed controls. Moderate quality evidence found no significant changes in cortisol levels or in the cortisol awakening response following psychosocial treatments for PTSD.

Moderate to high quality evidence found no significant differences in DHEA or DHEA-S levels compared to controls, apart from higher evening DHEA levels in people with PTSD when compared to non-trauma exposed controls.

August 2021

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Last updated at: 2:38 am, 2nd August 2021
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Fact Sheet Technical Commentary

NeuRA Libraries

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