Liyanarachchi, K., Ross, R. orcid.org/0000-0001-9222-9678 and Debono, M. (2017) Human studies on hypothalamo-pituitary-adrenal (HPA) axis. Best Practice & Research Clinical Endocrinology & Metabolism, 31 (5). pp. 459-473. ISSN 1521-690X
Abstract
The daily rhythm of the hypothalamo-pituitary-adrenal (HPA) axis is regulated by the central clock in the suprachiasmatic nucleus. Cortisol, a glucocorticoid, acts as a secondary messenger between the central clock and the peripheral tissues. Changes in clock time, as seen in shift workers, alters the HPA axis and results in metabolic disturbances associated with ill health. Depression, anorexia nervosa and obstructive sleep apnoea, are associated with cortisol rhythm phase shifts and increased cortisol exposure. Higher nocturnal cortisol exposure is observed in patients with Cushing's syndrome and adrenal incidentalomas with autonomous cortisol secretion and is associated with insulin resistance, and increased cardiovascular risk and mortality. A decrease in cortisol rhythm amplitude is seen in adrenal insufficiency, and despite replacement, patients have an impaired quality of life and increased mortality. Research on cortisol replacement has focused on replacing the cortisol daily rhythm by subcutaneous hydrocortisone infusions and oral modified release hydrocortisone formulations with the aim of improving disease control and quality of life.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 Published by Elsevier Ltd. |
Keywords: | clocks; cortisol rhythm; hydrocortisone; hypothalamo-pituitary-adrenal axis; jet lag; shift work; Adrenal Gland Neoplasms; Adrenal Insufficiency; Circadian Rhythm; Cushing Syndrome; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Oncology and Metabolism (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 23 Feb 2023 12:09 |
Last Modified: | 23 Feb 2023 12:10 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.beem.2017.10.011 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:196723 |