Thaller V, Vrkljan M, Hotujac L, Thakore J
Department of Psychiatry, University Hospital Sestre milosrdnice, Zagreb, Croatia.
Coll Antropol. 1999 Dec;23(2):611-9.
Different physical, chemical and psychological stressors can provoke a unique but different endocrine response involving activation of the hypothalamo-pituitary-adrenal (HPA) axis. Inability of adequate compensatory reaction can lead to many disorders. The aim of our study was comparison of cortisol values in diseases provoked by various stressors. Our investigation included 34 posttraumatic stress disorder (PTSD) patients, as an example of disorder caused by extremely strong, acute stressful stimulus, 19 psoriatic patients, as an example of chronic stress stimulus and 17 healthy volunteers. In each patient we determined 24-hour urinary cortisol, serum cortisol at 8 a.m. and 5 p.m., and cortisol in dexamethasone suppression test by the standard radioimmunoassay (RIA) method. PTSD patients showed lower urinary 24-hour cortisol values, (361 +/- 28 nmol/24 h), "stronger" circadian rhythm of serum cortisol (595 +/- 57 nmol/l at 8 a.m. and 242 +/- 23 nmol/l at 5 p.m.) and attenuated suppression of cortisol in dexamethasone suppression test (197 +/- 45 nmol/l) in comparison to healthy volunteers (590 +/- 87 nmol/24 h urine, 590 +/- 32 nmol/l at 8 a.m., 402 +/- 31 nmol/l, and < 86 nmol/l in dexa test). Psoriatic patients showed markedly lower 24-hour cortisol values (150 +/- 98 nmol/24 h), even in comparison to PTSD patients, then serum cortisol values (404 +/- 138 nmol/l at 8 a.m., 187 +/- 80 nmol/l at 5 p.m.) and enhanced suppression of cortisol (23 +/- 5 nmol/l). The model of attenuated feedback inhibition in PTSD patients shows that they are unusually reactive to stress and represents an alternative model of acute stress reaction to extremely strong stressful stimulus. Unusually low cortisol values in psoriatic patients correlate to our hypothesis that in chronic stress-related disease, as psoriasis is, exists, by still undefined mechanism, altered HPA axis function, which is obviously incompetent to realise its immunoregulatory function, so consequentially, clinical signs of psoriasis persist.
不同的物理、化学和心理应激源可引发独特但各异的内分泌反应，涉及下丘脑 - 垂体 - 肾上腺（HPA）轴的激活。充分代偿反应能力不足可导致多种疾病。我们研究的目的是比较由各种应激源引发的疾病中皮质醇值。我们的调查包括34名创伤后应激障碍（PTSD）患者，作为由极强的急性应激刺激引起的疾病的例子；19名银屑病患者，作为慢性应激刺激的例子；以及17名健康志愿者。在每位患者中，我们通过标准放射免疫分析（RIA）方法测定了24小时尿皮质醇、上午8点和下午5点的血清皮质醇，以及地塞米松抑制试验中的皮质醇。与健康志愿者相比（24小时尿皮质醇590±87 nmol/24 h，上午8点血清皮质醇590±32 nmol/l，下午5点402±31 nmol/l，地塞米松试验中<86 nmol/l），PTSD患者的24小时尿皮质醇值较低（361±28 nmol/24 h），血清皮质醇的昼夜节律“更强”（上午8点为595±57 nmol/l，下午5点为242±23 nmol/l），地塞米松抑制试验中皮质醇抑制减弱（197±45 nmol/l）。PTSD患者中反馈抑制减弱的模型表明，他们对应激异常敏感，代表了对极强应激刺激的急性应激反应的另一种模型。银屑病患者异常低的皮质醇值与我们的假设相关，即在慢性应激相关疾病如银屑病中，通过仍未明确的机制，HPA轴功能发生改变，显然无法实现其免疫调节功能，因此银屑病的临床症状持续存在。
