title: Inclusion of the glucocorticoid receptor in a hypothalamic pituitary adrenal axis model reveals bistability.
abstract: BACKGROUND
  The body's primary stress management system is the hypothalamic pituitary adrenal (HPA) axis. The HPA axis responds to physical and mental challenge to maintain homeostasis in part by controlling the body's cortisol level. Dysregulation of the HPA axis is implicated in numerous stress-related diseases.
  
  
  RESULTS
  We developed a structured model of the HPA axis that includes the glucocorticoid receptor (GR). This model incorporates nonlinear kinetics of pituitary GR synthesis. The nonlinear effect arises from the fact that GR homodimerizes after cortisol activation and induces its own synthesis in the pituitary. This homodimerization makes possible two stable steady states (low and high) and one unstable state of cortisol production resulting in bistability of the HPA axis. In this model, low GR concentration represents the normal steady state, and high GR concentration represents a dysregulated steady state. A short stress in the normal steady state produces a small perturbation in the GR concentration that quickly returns to normal levels. Long, repeated stress produces persistent and high GR concentration that does not return to baseline forcing the HPA axis to an alternate steady state. One consequence of increased steady state GR is reduced steady state cortisol, which has been observed in some stress related disorders such as Chronic Fatigue Syndrome (CFS).
  
  
  CONCLUSIONS
  Inclusion of pituitary GR expression resulted in a biologically plausible model of HPA axis bistability and hypocortisolism. High GR concentration enhanced cortisol negative feedback on the hypothalamus and forced the HPA axis into an alternative, low cortisol state. This model can be used to explore mechanisms underlying disorders of the HPA axis.
authors.affiliation: Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. shaktig@gmail.com
authors.forename: Shakti
authors.initials: S
authors.lastname: Gupta
authors.forename: Eric
authors.initials: E
authors.lastname: Aslakson
authors.forename: Brian M
authors.initials: BM
authors.lastname: Gurbaxani
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Vernon
mesh_terms: D000222:Adaptation, Physiological; D000324:Adrenocorticotropic Hormone / Q000096:biosynthesis; D000818:Animals; D006801:Humans; D006854:Hydrocortisone / Q000096:biosynthesis*; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D008954:Models, Biological; D010913:Pituitary-Adrenal System / Q000502:physiology*; D011965:Receptors, Glucocorticoid / Q000737:chemistry / Q000502:physiology*; D013315:Stress, Psychological / Q000503:physiopathology
chemical_list: D011965:Receptors, Glucocorticoid; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone