Kathol R G, Noyes R, Lopez A
University of Iowa Hospitals, Iowa City.
Psychiatr Clin North Am. 1988 Jun;11(2):335-48.
Psychologic stressors are less potent stimuli of the HPA axis in humans than physical stressors, but they can cause mild changes in acute ACTH and cortisol production. These changes, however, are generally not of sufficient magnitude or duration to cause measurable changes in UFC excretion. Furthermore, chronic stress leads to an attenuation of the HPA axis response. This basic knowledge concerning psychologic stress helps explain the reason why patients with uncomplicated anxiety/panic disorder, a condition involving similar symptoms, do not demonstrate UFC abnormalities. Panic disorder, when accompanied by depression, however, is associated with an increase in UFC excretion which is probably more related to the depression than the panic state. Interestingly, panic disorder, when accompanied by agoraphobia, also shows an elevation in UFC levels which makes it endocrinologically distinct from uncomplicated panic disorder. The reason for this is unclear. Treatment of the panic disorder with benzodiazepines does not further lower the UFC levels in patients with uncomplicated panic disorder despite clinical improvement, but it does lower UFC levels into the normal range in those with concurrent depression and agoraphobia. Alteration in the UFC level with treatment is only partially related to clinical improvement.
在人类中，心理应激源对下丘脑-垂体-肾上腺（HPA）轴的刺激作用不如身体应激源强大，但它们可引起促肾上腺皮质激素（ACTH）和皮质醇急性分泌的轻微变化。然而，这些变化的幅度和持续时间通常不足以导致尿游离皮质醇（UFC）排泄出现可测量的变化。此外，慢性应激会导致HPA轴反应减弱。关于心理应激的这一基本知识有助于解释为什么患有单纯性焦虑/惊恐障碍（一种具有类似症状的疾病）的患者没有表现出UFC异常。然而，惊恐障碍伴有抑郁时，与UFC排泄增加有关，这可能更多地与抑郁而非惊恐状态有关。有趣的是，惊恐障碍伴有广场恐惧症时，UFC水平也会升高，这使其在内分泌学上与单纯性惊恐障碍有所不同。其原因尚不清楚。用苯二氮䓬类药物治疗惊恐障碍，尽管临床症状有所改善，但对于患有单纯性惊恐障碍的患者，并不会进一步降低UFC水平，但对于同时伴有抑郁和广场恐惧症的患者，它确实会将UFC水平降至正常范围。治疗后UFC水平的改变仅部分与临床改善有关。
