Yale University School of Nursing, New Haven, CT 06539, USA.
J Am Psychiatr Nurses Assoc. 2011 Nov-Dec;17(6):393-403. doi: 10.1177/1078390311420564.
Cortisol secretions serve as the barometer of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates and controls responses to stress. Studies of cortisol secretions in patients with posttraumatic stress disorder (PTSD) reveal inconsistent results.
Current research on HPA axis functioning in PTSD is examined to elucidate the neuroendocrine contributions in the disorder, identify current treatment's impact on the HPA axis, and consider implications for nursing care and areas for future research.
There is evidence for HPA dysregulation in PTSD, which contributes to widespread impairment in functions such as memory and stress reactivity and to physical morbidity via processes such as allostatic load. There is limited, but building, evidence that dehydroepiandrosterone (DHEA), which is released simultaneously with cortisol, may provide anti-glucocorticoid and neuroprotective effects.
Current treatments such as selective serotonin reuptake inhibitors and psychotherapy may have a beneficial impact on the HPA axis in PTSD populations. Somatic approaches to treating PTSD have not yet been studied in relation to their impact on HPA axis parameters in PTSD patients. Treatment studies of DHEA or glucocorticoids have not yet used HPA axis endpoints. PTSD treatment studies that include measures of HPA axis target mechanisms and consider HPA axis regulation as an additional treatment outcome are warranted.
皮质醇分泌是下丘脑-垂体-肾上腺（HPA）轴的晴雨表，调节和控制对压力的反应。创伤后应激障碍（PTSD）患者皮质醇分泌的研究结果不一致。
检查 PTSD 中 HPA 轴功能的当前研究，以阐明该疾病中的神经内分泌贡献，确定当前治疗对 HPA 轴的影响，并考虑对护理的影响和未来研究的领域。
有证据表明 PTSD 存在 HPA 失调，这导致记忆和应激反应等功能广泛受损，并通过适应负荷等过程导致身体发病率增加。有有限但不断增加的证据表明，与皮质醇同时释放的脱氢表雄酮（DHEA）可能具有抗糖皮质激素和神经保护作用。
目前的治疗方法，如选择性 5-羟色胺再摄取抑制剂和心理治疗，可能对 PTSD 人群的 HPA 轴产生有益影响。针对 PTSD 的躯体治疗方法尚未研究其对 PTSD 患者 HPA 轴参数的影响。DHEA 或糖皮质激素的治疗研究尚未使用 HPA 轴终点。需要进行 PTSD 治疗研究，这些研究包括 HPA 轴靶机制的测量，并将 HPA 轴调节作为附加治疗结果考虑在内。
