Graeff Frederico G
Divisão de psiquiatria, Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Braz J Psychiatry. 2007 May;29 Suppl 1:S3-6. doi: 10.1590/s1516-44462007000500002.
This article focuses on the differential activation of the hypothalamic-pituitary-adrenal axis in generalized anxiety disorder and panic disorder.
The results of recently reported reviews of the literature are summarized and discussed.
The results of experimental studies that assayed adrenocorticotropic hormone, cortisol and prolactin show that real-life panic attacks, as well as those induced by selective panicogenic agents such as lactate and carbon dioxide, do not activate the hypothalamic-pituitary-adrenal axis. Agonists of the cholecystokinin receptor B such as the cholecystokinin-4 peptide and pentagastrin increase stress hormones regardless of the occurrence of a panic attack and, thus, seem to activate the hypothalamic-pituitary-adrenal axis directly. The benzodiazepine antagonist flumazenil does not increase stress hormones, but this agent does not reliably induce panic attacks. Pharmacological agents that increase anxiety in both normal people and panic patients (caffeine, yohimbine, serotonergic agonists) raise stress hormone levels.
In addition to the differences in symptomatology and pharmacological response, generalized anxiety disorder and panic disorder affect stress hormones in distinct ways. While anticipatory anxiety and generalized anxiety disorder activate both the hypothalamic-pituitary-adrenal and the sympathoadrenal axes, panic attack causes major sympathetic activation, but has little effect on the hypothalamic-pituitary-adrenal axis.
本文聚焦于广泛性焦虑症和惊恐障碍中下丘脑 - 垂体 - 肾上腺轴的差异激活。
总结并讨论近期文献综述的结果。
检测促肾上腺皮质激素、皮质醇和催乳素的实验研究结果表明，现实生活中的惊恐发作以及由选择性惊恐诱发剂如乳酸盐和二氧化碳诱发的惊恐发作，并不会激活下丘脑 - 垂体 - 肾上腺轴。胆囊收缩素B受体激动剂，如胆囊收缩素 - 4肽和五肽胃泌素，无论惊恐发作是否发生都会增加应激激素，因此似乎直接激活下丘脑 - 垂体 - 肾上腺轴。苯二氮䓬拮抗剂氟马西尼不会增加应激激素，但该药物不能可靠地诱发惊恐发作。在正常人和惊恐症患者中都会增加焦虑的药物（咖啡因、育亨宾、血清素能激动剂）会提高应激激素水平。
除了症状学和药理学反应的差异外，广泛性焦虑症和惊恐障碍以不同方式影响应激激素。预期性焦虑和广泛性焦虑症会激活下丘脑 - 垂体 - 肾上腺轴和交感肾上腺轴，而惊恐发作会导致主要的交感神经激活，但对下丘脑 - 垂体 - 肾上腺轴影响很小。
