title: Dissociation of ACTH and glucocorticoids.
abstract: It is increasingly clear that significant differential regulation of pituitary and adrenal gland activation exists, leading to a dissociation of plasma adrenocorticotropic hormone and corticosteroid secretion during fetal, postnatal and adult life. An increasing number of preclinical and clinical studies report dissociation of adrenocorticotropic hormone and cortisol levels in critical illness, inflammation and mental disorders. Mechanisms involve an altered adrenal sensitivity, aberrant receptor expression or modulation of adrenal function by cytokines, vasoactive factors or neuropeptides. The degree of dissociation has been associated with the level of complications of sepsis, surgery, malignant disease and depression. The separation of adrenocorticotropic hormone and corticosteroid secretion is of clinical relevance and should be incorporated into our view on endocrine stress regulation.
authors.affiliation: Medical Faculty Carl-Gustav-Carus of the Technical University Dresden, Dresden, Germany. Stefan.Bornstein@uniklinikum-dresden.de <Stefan.Bornstein@uniklinikum-dresden.de>
authors.forename: Stefan R
authors.initials: SR
authors.lastname: Bornstein
authors.forename: William C
authors.initials: WC
authors.lastname: Engeland
authors.forename: Monika
authors.initials: M
authors.lastname: Ehrhart-Bornstein
authors.forename: James P
authors.initials: JP
authors.lastname: Herman
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism*; D000818:Animals; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D010913:Pituitary-Adrenal System / Q000378:metabolism*
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone