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Assessment of the hypothalamic–pituitary–adrenal axis activity: glucocorticoid receptor and mineralocorticoid receptor function in depression with early life stress – a systematic review

Published online by Cambridge University Press:  24 June 2014

Cristiane Von Werne Baes ,
Sandra M. de Carvalho Tofoli ,
Camila Maria S. Martins  and
Mario F. Juruena
Cristiane Von Werne Baes
Affiliation:
Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brasil
Sandra M. de Carvalho Tofoli
Affiliation:
Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brasil
Camila Maria S. Martins
Affiliation:
Department of Neuroscience and Behaviour, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brasil
Mario F. Juruena*
Affiliation:
Stress and Affective Disorders Programme, Department of Neurosciences and Behaviour, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brasil
*
Mario F. Juruena, Department of Neurosciences and Behaviour, Faculty of Medicine Ribeirao Preto, Saude Mental-USP, Av. Tenente Catao Roxo, 2650, Monte Alegre-Campus Universitario, University of Sao Paulo, Ribeirao Preto, Sao Paulo 14051-140, Brasil. Tel: +55 16 36307961; Fax: +55 16 36307961; E-mail: [email protected]
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Extract

Objective: The mechanisms involved in the dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, especially in the functioning of glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) in depressed patients, are not well elucidated. The objective of this study was to conduct a systematic review of articles that assess the HPA axis activity from GR and MR in depressed patients and healthy controls with or without early life stress.

Methods: We conducted a systematic review of articles in PubMed, SCOPUS and SciELO published between 2000 and 2011, using the following search terms: child abuse, depression, HPA axis, dexamethasone, prednisolone, fludrocortisone and spironolactone. Thirty-four papers were selected for this review.

Results: Most studies identified in this review used the dexamethasone/corticotropin-releasing hormone test and dexamethasone suppression test. In these studies, hypercortisolaemia was associated with depression. We identified three studies with the Prednisolone suppression test, only one study with the use of fludrocortisone and one with spironolactone. This review found nine studies that evaluated the HPA axis in individuals with early life stress.

Conclusions: The majority of the studies assessed in this review show that early life stress leads to permanent changes in the HPA axis and may lead to development of depression in adults. The most consistent findings in the literature show increased activity of the HPA axis in depression associated with hypercortisolaemia and reduced inhibitory feedback. These findings suggest that this dysregulation of the HPA axis is partially attributable to an imbalance between GR and MR. Evidences have consistently showed that GR function is impaired in major depression, but few studies have assessed the activity of MR in depression and early life stress.

Keywords

affective disordercorticoidscortisolhypothalmo–pituitary–adrenal axisneuroendocrinologypituitary glandstress
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 24 , Issue 1 , February 2012 , pp. 4 - 15
Copyright
Copyright © Cambridge University Press 2011

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