RESUMEN
Considerable evidence has indicated that psychological factors,such as anxiety,nervousness and mental stress,can induce or exacerbate psoriasis and affect therapeutic effects to a certain degree,suggesting that psychological factors may play an important role in the occurrence of psoriasis.Current researches on neuropsychiatry-related pathogenesis of psoriasis mainly include two aspects:on the one hand,acting as stressors,psychological factors can activate the following two neuroendocrine systems,including hypothalamic-pituitary-adrenocortical axis and sympathetic-adrenal medullary system;on the other hand,neuropeptides and nerve growth factors induce in vivo neurogenic inflammation.Neuropsychiatric factors may participate in the occurrence of psoriasis through the above pathways.
RESUMEN
Stress-related diseases are closely related to an abnormal cortisol secretion.Recent research implied that hair cortisol concentration which retrospectively records long-term cortisol basal level might possess superiority in the diagnosis of stresS-related diseases.This paper reviewed recent progresses in application of hair cortisol concentration in stress-related diseases (metabolic syndrome,obesity,cardiovascular disease,depression,PTSD,etc.) which showed abnormal long-term cortisol secretion in a wide range of situationS.This review proposed that the future research needs to take into accounts exclusion and/or balance of the influence factors,a longitudinal design in combination with acute-stress and chronic-stress biomarkers,and to develop new bio-markers related to hair cortisol concentration for study of stress related diseases,and establishment of standard protocols and clinical standards.
RESUMEN
BACKGROUND: In subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown. METHODS: Thirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test. RESULTS: Levels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (P=0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months, P<0.001). CONCLUSION: The HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.