Ring Melinda
Osher Center for Integrative Health at Northwestern University, Chicago, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill.
Am J Med. 2025 Jun 9. doi: 10.1016/j.amjmed.2025.05.044.
The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in the body's stress response and is increasingly recognized as a contributor to a range of chronic health conditions. This review aims to provide an evidence-based overview of HPA axis dysregulation, including its underlying mechanisms, diagnostic approaches, and integrative treatment strategies.
A comprehensive review of peer-reviewed literature was conducted to examine the multifactorial contributors to HPA axis dysfunction. Sources included studies on psychological stress, dietary and lifestyle factors, genetic and epigenetic influences, immune system interactions, gut health, inflammation, environmental toxins, and hormonal imbalances. Diagnostic modalities such as serum and salivary cortisol testing were also reviewed.
HPA axis dysfunction is influenced by a complex interplay of internal and external stressors, including chronic psychological stress, dietary imbalances, disrupted circadian rhythms, and environmental exposures. Diagnostic methods vary in sensitivity and clinical utility, with diurnal salivary cortisol profiles offering insight into functional patterns. Integrative treatment approaches include patient-centered care, mind-body therapies, dietary and lifestyle interventions, targeted nutraceuticals, and adaptogenic herbs-each aimed at restoring balance and improving stress resilience.
Understanding HPA axis dysregulation through an integrative lens supports a more individualized and comprehensive approach to care. By bridging conventional endocrinology and functional medicine, clinicians are better equipped to address commonly overlooked symptoms such as fatigue, insomnia, mood disturbances, and poor stress tolerance, ultimately enhancing patient outcomes.
下丘脑 - 垂体 - 肾上腺（HPA）轴在身体的应激反应中起核心作用，并且越来越被认为是一系列慢性健康状况的一个促成因素。本综述旨在提供基于证据的HPA轴失调概述，包括其潜在机制、诊断方法和综合治疗策略。
对同行评审文献进行了全面综述，以研究导致HPA轴功能障碍的多因素促成因素。资料来源包括关于心理应激、饮食和生活方式因素、遗传和表观遗传影响、免疫系统相互作用、肠道健康、炎症、环境毒素和激素失衡的研究。还对血清和唾液皮质醇检测等诊断方式进行了综述。
HPA轴功能障碍受内部和外部应激源复杂相互作用的影响，包括慢性心理应激、饮食失衡、昼夜节律紊乱和环境暴露。诊断方法在敏感性和临床实用性方面各不相同，昼夜唾液皮质醇谱可洞察功能模式。综合治疗方法包括以患者为中心的护理、身心疗法、饮食和生活方式干预、靶向营养保健品和适应原草药——每种方法都旨在恢复平衡并提高应激恢复力。
通过综合视角理解HPA轴失调支持采用更个性化和全面的护理方法。通过将传统内分泌学与功能医学相结合，临床医生能更好地处理疲劳、失眠、情绪障碍和应激耐受性差等常见被忽视的症状，最终改善患者预后。
