스트레스와 피로 논문

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스트레스와 피로

논문으로 공부해봐야지!

The hypothalamo–pituitary–adrenal axis in chronic fatig.pdf

Hypothalamic-Pituitary-Adrenal Axis and chronic fatigue syn.pdf

4. 스트레스와 에너지 대사

- 스트레스를 받으면 우리몸의 모든 에너지 저장단계는 당질코르티코이드, 글루카곤, 에피네프린, 노르에피네프린 등의 스트레스 호르몬에 의해 역전된다. 이들은 TG를 지방세포에서 분해하고, 그 결과로서 유리지방산과 글리세롤을 순환계에 쏟아내 에너지로 사용하게 한다. 또한 온몸의 세포에서 글리코겐이 포도당으로 분해되는 것을 촉발한다. 또한 운동을 필요로 하지 않는 근육에서 단백질을 아미노산으로 바뀌게 한다.

- 식사를 잘하면 췌장에서 인슐린이 나와 지방세포로의 지방산 수송 및 글리코겐과 단백질의 합성을 촉진.

- 당신이 매일 저녁 6시에 식사를 한다고 치면, 혈류속에 포도당의 수준이 증가할 것을 기대하고 5시 45분에 인슐린이 분비되기 시작한다. 이런 "기대성 분비"는 부교감신경계가 자극된 결과인데, 이렇게 포도당 수준이 곧 상승할 것에 대비하여 인슐린을 분비하는 능력은 신항상성을 가지는 기대성 특징의 좋은 예가 된다.

- 스트레스 상황에서는 인슐린 분비 저하되어 인슐린에 의한 에너지 저장이 중단된다. 오직 사용하는데 급급한것이다. 아미노산은 좋은 에너지원이 아니기 때문에 간으로 보내서 포도당으로 만들어낸다(gluconeogenesis). 이렇게 만들어진 포도당은 엄청난 폭발력을 만들어내는 것이다.

- 위기에서 에너지를 동원할 수 없다면 어떻게 될까?  당질 코르티코이드를 적절히 분비하지 못하는 에디슨병환자들, 에피네프린 이 부적절하게 분비되는 샤이드래거 증후군 환자들은 필요한 순간에 에너지를 동원하지 못한다.

- "만성피로증후군"을 앓는 사람들은? 이들은 무엇보다도 혈류속의 당질 코르티코이드 수준이 너무 낮은 것이 특징이다.

panic bird.......

1: Med Hypotheses. 2009 Jun;72(6):701-5. Epub 2009 Feb 23. Links

Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a 'crash' in the stress system?

Van Houdenhove B, Van Den Eede F, Luyten P.

Department of Liaison Psychiatry, University Hospitals K.U. Leuven, Herestraat 49, B-3000 Leuven, Belgium. boudewijn.vanhoudenhove@uz.kuleuven.ac.be

The etiopathogenesis of chronic fatigue syndrome (CFS) remains poorly understood. Although neuroendocrine disturbances - and hypothalamic-pituitary-adrenal (HPA) axis hypofunction in particular - have been found in a large proportion of CFS patients, it is not clear whether these disturbances are cause or consequence of the illness. After a review of the available evidence we hypothesize that that HPA axis hypofunction in CFS, conceptualized within a system-biological perspective, primarily reflects a fundamental and persistent dysregulation of the neurobiological stress system. As a result, a disturbed balance between glucocorticoid and inflammatory signaling pathways may give rise to a pathological cytokine-induced sickness response that may be the final common pathway underlying central CFS symptoms, i.e. effort/stress intolerance and pain hypersensitivity. This comprehensive hypothesis on HPA axis hypofunction in CFS may stimulate diagnostic refinement of the illness, inform treatment approaches and suggest directions for future research, particularly focusing on the neuroendocrine-immune interface and possible links between CFS, early and recent life stress, and depression.

1: Neuropsychobiology. 2007;55(2):112-20. Epub 2007 Jun 27. Links

Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome.

Van Den Eede F, Moorkens G, Van Houdenhove B, Cosyns P, Claes SJ.

Department of Psychiatry, University Hospital Antwerp, Edegem, Belgium. filip.van.den.eede@uza.be

There is evidence for a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis in a proportion of the patients with chronic fatigue syndrome (CFS), despite the negative studies and methodological difficulties. In this review, we focus on challenge studies and on the role of the HPA axis in the pathogenesis of CFS. Mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids are the main findings. Several underlying mechanisms have been proposed. Currently, it is a matter of debate whether these disturbances have a primary role in the pathogenesis of CFS. However, even if the HPA axis dysfunctions are secondary to other factors, they are probably a relevant factor in symptom propagation in CFS.

1: Trends Endocrinol Metab. 2004 Mar;15(2):55-9. Links

The HPA axis and the genesis of chronic fatigue syndrome.

Cleare AJ.

Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London, SE5 8AF, UK. a.cleare@iop.kcl.ac.uk

Many studies of patients with long-standing chronic fatigue syndrome (CFS) have found alterations to the hypothalamo-pituitary-adrenal (HPA) axis, including mild hypocortisolism, heightened negative feedback and blunted responses to challenge. However, recent prospective studies of high-risk cohorts suggest that there are no HPA axis changes present during the early stages of the genesis of fatiguing illnesses. Moreover, HPA axis changes can be reversed by modifying behavioural features of the illness, such as inactivity, deconditioning and sleep disturbance. Nevertheless, raising levels of cortisol pharmacologically can temporarily alleviate symptoms of fatigue. This article presents the case that there is no specific change to the HPA axis in CFS and that the observed changes are of multifactorial aetiology, with some factors occurring as a consequence of the illness. Nevertheless, the HPA axis might play a role in exacerbating or perpetuating symptoms late on in the course of the illness.

1: Stress. 2007 Mar;10(1):13-25. Links

The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome.

Tanriverdi F, Karaca Z, Unluhizarci K, Kelestimur F.

Department of Endocrinology, Medical School, Erciyes University, Kayseri, Turkey.

The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic pain and post-traumatic stress disorder are characterized by alterations in HPA axis activity. However, the role of the HPA axis alterations in these stress-related disorders is not clear. Most studies have shown that the HPA axis is underactive in the stress-related disorders, but contradictory results have also been reported, which may be due to the patients selected for the study, the methods used for the investigation of the HPA axis, the stage of the syndrome when the tests have been done and the interpretation of the results. There is no structural abnormality in the endocrine organs which comprise the HPA axis, thus it seems that hypocortisolemia found in the patients with stress-related disorder is functional. It may be also an adaptive response of the body to chronic stress. In this review, tests used in the assessment of HPA axis function and the HPA axis alterations found in CFS and FMS are discussed in detail.

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