Dysregulation of HPA Axis in Post-Traumatic Stress Disorder

Yıl 2018, Cilt: 27 Sayı: 1, 109 - 125, 31.03.2018

Miraç Barış Usta

https://doi.org/10.17827/aktd.345474

Öz

Many endocrinological studies have evaluated the role of the hypothalamic-pituitary-adrenal axis in the pathophysiology of post-traumatic stress disorder and have created models. There are many reasons for looking for biomarkers, especially in monitoring treatment effectiveness, and the fact that trauma victims differ in terms of comorbidity, clinical appearance, trauma etiology, and time after trauma lead to variatons in findings. In this review, methods and findings of studies investigating the effects on hypothalamic-pituitary-adrenal function in post-traumatic stress disorder and the findings about hypothalamic-pituitary-adrenal axis hormones tested as biological therapy markers have been discussed.

Anahtar Kelimeler

HPA, PTSD, Biological biomarker, psychotherapy

Travma Sonrası Stres Bozukluğunda HPA Ekseninin Disregülasyonu

Öz

Endokrinolojik çalışmalar hipotalamik-pitüiter-adrenal ekseninin travma sonrası stres bozukluğu patofizyolojisinde rolünü değerlendirmiş ve modeller oluşturmuştur. Travma sonrası stres bozukluğunda tedavi etkinliğinin izlenmesi başta olmak üzere birçok nedenle biyolojik belirteç arayışı söz konusudur ve travma mağduru hastalarının komorbidite, klinik görünüm, travma etiyolojisi ve travmadan sonra geçen zaman açısından farklılar göstermesi bulgularda çeşitliliklere sebep olmuştur. Bu gözden geçirmede, travma sonrası stres bozukluğunda hipotalamik-pitüiter-adrenal ekseninin fonksiyonu üzerine etkilerini araştıran çalışmaların yöntem ve bulguları gözden geçirilmiştir ve biyolojik terapi belirteci olarak denenen hipotalamik-pitüiter-adrenal ekseninin hormonları ile ilgili bulgular tartışılmıştır.

Anahtar Kelimeler

TSSB, psikoterapi, HPA, biyolojik belirtec

Kaynakça

• 1. Saigh PA, Bremner JD. The history of posttraumatic stress disorder. In P. A. Saigh & J. D. Bremner (Eds.), Posttraumatic stress disorder: A comprehensive text (pp. 1-17).
• 2. Grob GN. Origins of DSM-I: A study in appearance and reality. Am J Psychiatry 1991;148:421-31.
• 3. Diagnostic and Statistical Manual of Mental Disorders, third edition. American Psychiatric Association, 1980.
• 4. Friedman M. PTSD history and overview. National Center for PTSD January 2007.
• 5. Diagnostic and Statistical Manual of Mental Disorders, fourth edition. American Psychiatric Association, 2000.
• 6. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593-602.
• 7. Terr LC. Chowchilla revisited: The effects of psychic trauma four years after a school-bus kidnapping. Am J Psychiatry 1983;140:1543-50.
• 8. Dyregrov A, Yule W. A review of PTSD in children. Child Adolesc Ment Health 2006;11:176-84.
• 9. Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. J Psychol Med 2008;38:467-80.
• 10. Diagnostic and Statistical Manual of Mental Disorders, fifth Edition. American Psychiatric Association, 2013.
• 11. Scheeringa MS, Zeanah CH, Cohen JA. PTSD in children and adolescents: toward an empirically based algorithma. Depress Anxiety 2011;28:770-82.
• 12. Dalgleish T, Goodall B, Chadwick I, Werner-Seidler A, McKinnon A, Morant N, et al. Trauma-focused cognitive behaviour therapy versus treatment as usual for post traumatic stress disorder in young children aged 3 to 8 years: study protocol for a randomised controlled trial. Trials 2015;16:116.
• 13. Van der Kolk B, Greenberg M, Boyd H, Krystal J. Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress. Biol Psychiatry 1985;20:314-25.
• 14. Bonne O, Brandes D, Gilboa A, Gomori JM, Shenton ME, Pitman RK, et al. Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD. Am J Psychiatry 2001.
• 15. Yehuda R, Pratchett LC, Elmes MW, Lehrner A, Daskalakis NP, Koch E, et al. Glucocorticoid-related predictors and correlates of post-traumatic stress disorder treatment response in combat veterans. Interface focus 2014;4:20140048.
• 16. De Bellis MD, Hall J, Boring AM, Frustaci K, Moritz G. A pilot longitudinal study of hippocampal volumes in pediatric maltreatment-related posttraumatic stress disorder. Biol Psychiatry 2001;50:305-9.
• 17. De Bellis MD, Keshavan MS, Spencer S, Hall J. N-Acetylaspartate concentration in the anterior cingulate of maltreated children and adolescents with PTSD. Am J Psychiatry 2014.
• 18. De Bellis MD, Keshavan MS, Frustaci K, Shifflett H, Iyengar S, Beers SR, et al. Superior temporal gyrus volumes in maltreated children and adolescents with PTSD. Biol Psychiatry 2002;51:544-52.
• 19. Shalev AY, Videlock EJ, Peleg T, Segman R, Pitman RK, Yehuda R. Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part I: HPA axis responses. Int J Neuropsychopharmacol 2008;11:365-72.
• 20. Olff M, de Vries G-J, Güzelcan Y, Assies J, Gersons BP. Changes in cortisol and DHEA plasma levels after psychotherapy for PTSD. Psychoneuroendocrinology 2007;32:619-26.
• 21. Gerardi M, Rothbaum BO, Astin MC, Kelley M. Cortisol response following exposure treatment for PTSD in rape victims. J Aggress Maltreat Trauma 2010;19:349-56.
• 22. Nijdam M, van Amsterdam J, Gersons B, Olff M. Dexamethasone-suppressed cortisol awakening response predicts treatment outcome in posttraumatic stress disorder. J Affect Disord 2015;184:205-8.
• 23. Kimbrel NA, Morissette SB, Meyer EC, Chrestman R, Jamroz R, Silvia PJ, et al. Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder, depression, anxiety, and quality of life among Iraq and Afghanistan veterans. Anxiety Stress Coping 2015;28(4):456-66.
• 24. Heim C, Mletzko T, Purselle D, Musselman DL, Nemeroff CB. The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Biol Psychiatry 2008;63:398-405.
• 25. Yehuda R, Brand S, Golier J, Yang RK. Clinical correlates of DHEA associated with post‐traumatic stress disorder. Acta Psychiatr Scand 2006;114:187-93.
• 26. Lupien SJ, Maheu F, Tu M, Fiocco A, Schramek TE. The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain Cogn 2007;65:209-37.
• 27. Herman JP, Figueiredo H, Mueller NK, Ulrich-Lai Y, Ostrander MM, Choi DC, et al. Central mechanisms of stress integration: hierarchical circuitry controlling hypothalamo–pituitary–adrenocortical responsiveness. Front Neuroendocrinol 2003;24:151-80.
• 28. Brown RE. An introduction to neuroendocrinology: Cambridge University Press Cambridge; 1994.
• 29. McEwen BS. The neurobiology of stress: from serendipity to clinical relevance. Brain Res Rev 2000;886:172-89.
• 30. Herman JP, Cullinan WE. Neurocircuitry of stress: central control of the hypothalamo–pituitary–adrenocortical axis. Trends Neurosci 1997;20:78-84.
• 31. Herman JP, Ostrander MM, Mueller NK, Figueiredo H. Limbic system mechanisms of stress regulation: hypothalamo-pituitary-adrenocortical axis. Prog Neuropsychopharmacol Biol Psychiatry 2005;29:1201-13.
• 32. Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher T, Hellman L. Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J Clin Endocrinol Metab 1971;33:14-22.
• 33. Pruessner JC, Dedovic K, Khalili-Mahani N, Engert V, Pruessner M, Buss C, et al. Deactivation of the limbic system during acute psychosocial stress: evidence from positron emission tomography and functional magnetic resonance imaging studies. Biol Psychiatry. 2008;63:234-40.
• 34. Dickerson SS, Kemeny ME. Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull 2004;130:355.
• 35. Price JL. Comparative aspects of amygdala connectivity. Annals of the New York Academy of Sciences 2003;985:50-8.
• 36. Meaney MJ, Plotsky PM. Long-term behavioral and neuroendocrine adaptations to adverse early experience. The Biological Basis For Mind Body Interactions 2000;122:81.
• 37. Plotsky PM, Thrivikraman K, Nemeroff CB, Caldji C, Sharma S, Meaney MJ. Long-term consequences of neonatal rearing on central corticotropin-releasing factor systems in adult male rat offspring. Neuropsychopharmacology 2005;30:2192-204.
• 38. Härfstrand A, Fuxe K, Cintra A, Agnati LF, Zini I, Wikström A-C, et al. Glucocorticoid receptor immunoreactivity in monoaminergic neurons of rat brain. Proceedings of the National Academy of Sciences 1986;83:9779-83.
• 39. Pruessner JC, Champagne F, Meaney MJ, Dagher A. Dopamine release in response to a psychological stress in humans and its relationship to early life maternal care: a positron emission tomography study using [11C] raclopride. J Neurosci 2004;24:2825-31.
• 40. Glover DA, Poland RE. Urinary cortisol and catecholamines in mothers of child cancer survivors with and without PTSD. Psychoneuroendocrinology 2002;27:805-19.
• 41. Jensen CF, Keller TW, Peskind ER, McFall ME, Veith RC, Martin D, et al. Behavioral and neuroendocrine responses to sodium lactate infusion in subjects with posttraumatic stress disorder. Am J Psychiatry 1997;154:266-8.
• 42. Kellner M, Baker DG, Yehuda R. Salivary cortisol in Operation Desert Storm returnees. Biol Psychiatry 1997;42:849-50.
• 43. Mason JW, Giller EL, Kosten TR, Ostroff RB, Podd L. Urinary free-cortisol levels in posttraumatic stress disorder patients. J Nerv Ment Dis 1986;174:145-9.
• 44. Thaller V, Vrkljan M, Hotujac L, Thakore J. The potential role of hypocortisolism in the pathophysiology of PTSD and psoriasis. Coll Antropol 1999;23:611-9.
• 45. Yehuda R. Psychoneuroendocrinology of post-traumatic stress disorder. Psychiatr Clin North Am 1998;21:359-79.
• 46. Yehuda R, Southwick SM, Nussbaum G, Wahby V, Giller EL, Jr., Mason JW. Low urinary cortisol excretion in patients with posttraumatic stress disorder. J Nerv Ment Dis 1990;178:366-9.
• 47. Trickett PK, Noll JG, Susman EJ, Shenk CE, Putnam FW. Attenuation of cortisol across development for victims of sexual abuse. Dev Psychopathol 2010;22:165-75.
• 48. Walsh K, Nugent NR, Kotte A, Amstadter AB, Wang S, Guille C, et al. Cortisol at the Emergency Room Rape Visit as a Predictor of PTSD and Depression Symptoms Over Time. Psychoneuroendocrinology 2013;38.
• 49. Keeshin BR, Strawn JR, Out D, Granger DA, Putnam FW. Cortisol awakening response in adolescents with acute sexual abuse related posttraumatic stress disorder. Depress Anxiety 2014;31:107-14.
• 50. Walsh K, Nugent NR, Kotte A, Amstadter AB, Wang S, Guille C, et al. Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time. Psychoneuroendocrinology 2013;38:2520-8.
• 51. Yehuda R. Neuroendocrinology of trauma and PTSD. Annu Rev Psychol 1998;17:97-131.
• 52. Weaver IC, Cervoni N, Champagne FA, D'Alessio AC, Sharma S, Seckl JR, et al. Epigenetic programming by maternal behavior. Nature Neuroscience 2004;7:847-54.
• 53. Olsson T, Mohammed AH, Donaldson LF, Henriksson BG, Seckl JR. Glucocorticoid receptor and NGFI-A gene expression are induced in the hippocampus after environmental enrichment in adult rats. Mol Brain Res 1994;23:349-53.
• 54. Yehuda R, Flory JD, Bierer LM, Henn-Haase C, Lehrner A, Desarnaud F, et al. Lower Methylation of Glucocorticoid Receptor Gene Promoter 1 F in Peripheral Blood of Veterans with Posttraumatic Stress Disorder. Biol Psychiatry 2015;77:356-64.
• 55. Najarian LM, Fairbanks LA. Basal cortisol, dexamethasone suppression of cortisol, and MHPG in adolescents after the 1988 earthquake in Armenia. Am J Psychiatry 1996;153:929-34.
• 56. Pajer K, Gardner W, Rubin RT, Perel J, Neal S. Decreased cortisol levels in adolescent girls with conduct disorder. Arch Gen Psychiatry 2001;58:297-302.
• 57. Lipschitz DS, Rasmusson AM, Yehuda R, Wang S, Anyan W, Gueoguieva R, et al. Salivary cortisol responses to dexamethasone in adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 2003;42:1310-7.
• 58. Pervanidou P, Kolaitis G, Charitaki S, Lazaropoulou C, Papassotiriou I, Hindmarsh P, et al. The natural history of neuroendocrine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: progressive divergence of noradrenaline and cortisol concentrations over time. Biol Psychiatry 2007;62:1095-102.
• 59. Weems CF, Carrión VG. Brief report: Diurnal salivary cortisol in youth—Clarifying the nature of posttraumatic stress dysregulation. J Pediatr Psychol 2009;34:389-95.
• 60. MacMillan HL, Georgiades K, Duku EK, Shea A, Steiner M, Niec A, et al. Cortisol response to stress in female youths exposed to childhood maltreatment: results of the youth mood project. Biol Psychiatry 2009;66:62-8.
• 61. Suglia SF, Staudenmayer J, Cohen S, Wright RJ. Posttraumatic stress symptoms related to community violence and children’s diurnal cortisol response in an urban community-dwelling sample. Int J Behav Med 2010;17:43-50.
• 62. Gustafsson PE, Nelson N, Gustafsson PA. Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents. Nord J Psychiatry 2010;64:27-31.
• 63. Luo H, Hu X, Liu X, Ma X, Guo W, Qiu C, et al. Hair cortisol level as a biomarker for altered hypothalamic-pituitary-adrenal activity in female adolescents with posttraumatic stress disorder after the 2008 Wenchuan earthquake. Biol Psychiatry 2012;72:65-9.
• 64. Bicanic IA, Postma RM, Sinnema G, De Roos C, Olff M, Van Wesel F, et al. Salivary cortisol and dehydroepiandrosterone sulfate in adolescent rape victims with post traumatic stress disorder. Psychoneuroendocrinology 2013;38:408-15.
• 65. Pfefferbaum B, Tucker P, Nitiéma P, editors. Adolescent survivors of Hurricane Katrina: a pilot study of hypothalamic–pituitary–adrenal axis functioning. Child & Youth Care Forum; 2015: Springer.
• 66. Simsek S, Uysal C, Kaplan I, Yuksel T, Aktas H. BDNF and cortisol levels in children with or without post-traumatic stress disorder after sustaining sexual abuse. Psychoneuroendocrinology 2015;56:45-51.
• 67. Kroboth PD, Salek FS, Pittenger AL, Fabian TJ, Frye RF. DHEA and DHEA‐S: a review. J Clin Pharmacol 1999;39:327-48.
• 68. Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)—a precursor steroid or an active hormone in human physiology. J Sex Med 2011;8:2960-82. 69. Thijs L, Fagard R, Forette F, Nawrot T, Staessen JA. Are low dehydroepiandrosterone sulphate levels predictive for cardiovascular diseases? A review of prospective and retrospective studies. Acta Cardiol 2003;58:403-10.
• 70. Chen CC, Parker Jr CR, editors. Adrenal androgens and the immune system. Semin Reprod Med; 2004.
• 71. Dharia S, Parker Jr CR, editors. Adrenal androgens and aging. Semin Reprod Med; 2004.
• 72. Parker Ln, Levin Er, Lifrak Et. Evidence for Adrenocortical Adaptation to Severe Illness. J Clin Endocrinol Metab 1985;60:947-52.
• 73. Tchernof A, Labrie F. Dehydroepiandrosterone, obesity and cardiovascular disease risk: a review of human studies. Eur J Endocrinol 2004;151:1-14.
• 74. Altman R, Motton DD, Kota RS, Rutledge JC. Inhibition of vascular inflammation by dehydroepiandrosterone sulfate in human aortic endothelial cells: roles of PPARα and NF-κB. Curr Vasc Pharmacol 2008;48:76-84.
• 75. Corpechot C, Robel P, Axelson M, Sjövall J, Baulieu E-E. Characterization and measurement of dehydroepiandrosterone sulfate in rat brain. Proc Natl Acad Sci U S A 1981;78:4704-7.
• 76. Watkins J, Evans R. Excitatory amino acid transmitters. Annu Rev Pharmacol Toxicol 1981;21:165-204.
• 77. Morgan CA, Southwick S, Hazlett G, Rasmusson A, Hoyt G, Zimolo Z, et al. Relationships Among Plasma Dehydroepiandrosterone Sulfate and CortisolLevels, Symptoms of Dissociation, and Objective Performance in Humans Exposedto Acute Stress. Arch Gen Psychiatry 2004;61:819-25.
• 78. Boscarino JA. Psychobiologic predictors of disease mortality after psychological trauma: implications for research and clinical surveillance. J Nerv Ment Dis 2008;196:100-7.
• 79. Usta MB, Tuncel OK, Akbas S, Aydin B, Say GN. Decreased dehydroepiandrosterone sulphate levels in adolescents with post-traumatic stress disorder after single sexual trauma. Nord J Psychiatry 2015:1-5.
• 80. Mouthaan J, Sijbrandij M, Luitse JS, Goslings JC, Gersons BP, Olff M. The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms. Psychoneuroendocrinology 2014;45:179-86.
• 81. Von Muhlen D, Laughlin GA, Kritz-Silverstein D, Barrett-Connor E. The Dehydroepiandrosterone And WellNess (DAWN) study: research design and methods. Contemp Clin Trials 2007;28:153-68.
• 82. Taylor MK, Padilla GA, Stanfill KE, Markham AE, Khosravi JY, Dial Ward MD, et al. Effects of dehydroepiandrosterone supplementation during stressful military training: a randomized, controlled, double-blind field study. Stress 2012;15:85-96.
• 83. Maninger N, Wolkowitz OM, Reus VI, Epel ES, Mellon SH. Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS). Front Neuroendocrinol 2009;30:65-91.
• 84. Rasmusson AM, Vasek J, Lipschitz DS, Vojvoda D, Mustone ME, Shi Q, et al. An increased capacity for adrenal DHEA release is associated with decreased avoidance and negative mood symptoms in women with PTSD. Neuropsychopharmacology 2004;29:1546-57.
• 85. Gill J, Vythilingam M, Page GG. Low cortisol, high DHEA, and high levels of stimulated TNF‐α, and IL‐6 in women with PTSD. J Trauma Stress 2008;21:530-9.
• 86. Kellner M, Muhtz C, Peter F, Dunker S, Wiedemann K, Yassouridis A. Increased DHEA and DHEA-S plasma levels in patients with post-traumatic stress disorder and a history of childhood abuse. J Psychiatr Res 2010;44:215-9.
• 87. Van Voorhees EE, Dennis MF, Calhoun PS, Beckham JC. Association of DHEA, DHEAS, and cortisol with childhood trauma exposure and posttraumatic stress disorder. Int Clin Psychopharmacol 2014;29:56.
• 88. de Vries G-J, Lok A, Mocking R, Assies J, Schene A, Olff M. Altered one-carbon metabolism in posttraumatic stress disorder. J Affect Disord 2015;184:277-85.
• 89. Postma R. The Cortisol Awakening Response in Raped Adolescent Girls with PTSD. Master Thesis, University of Utrecht 2009.