Role of endocrine and inflammatory alterations in comorbid somatic diseases of post-traumatic stress disorder.

Since its first description in the Diagnostic and Statistical Manual for Mental Disorders, post-traumatic stress disorder (PTSD) has been characterized as a disorder of altered affective functioning which causes tremendous distress. In addition, it has been recognized that PTSD is not only accompanied by ''poor health'' but also by a number of specific and non-specific ''somatic'' pathologies, such as cardiovascular, autoimmune and physical complaints/chronic pain. It has been hypothesized that alterations of the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic-adrenal-medullary (SAM) and the immune system may mediate or facilitate these somatic conditions. The aims of this review are to summarize studies that report altered somatic functioning in PTSD and to review how endocrine and immune function differentially affect PTSD-related somatic malfunction. It is hypothesized that alterations of HPA axis and SAM system permit disinhibition of inflammatory mechanisms, which in turn foster the development of somatic diseases as well as self-reported physical complaints.