title: Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus-pituitary-adrenal (HPA) axis responses to a low-dose ACTH1-24 (Synacthen) and dexamethasone-CRH test in healthy school teachers.
abstract: Evidence for a detrimental impact of chronic work stress on health has accumulated in epidemiological research. Recent studies indicate altered hypothalamus-pituitary-adrenal (HPA) axis regulation as a possible biological pathway underlying the link between stress and disease. However, the direction of dysregulation remains unclear, with reported HPA hyper- or hyporeactivity. To disentangle potential effects on different functional levels in the HPA axis, we examined responses using two pharmacological stimulation tests in 53 healthy teachers (31 females, 22 males; mean age: 49.3 years; age range: 30-64 years): a low-dose adrenocorticotrophic hormone (ACTH(1-24), Synacthen) test was used to assess adrenal cortex sensitivity and the combined dexamethasone-corticotropin releasing hormone (DEX-CRH) test to examine pituitary and adrenal cortex reactivity. Blood and saliva samples were collected at - 1,+15,+30,+45,+60,+90,+120 min. Emotional exhaustion (EE), the core dimension of burnout, was measured with the Maslach Burnout Inventory. Overcommitment (OC) was assessed according to Siegrist's effort-reward-imbalance model. We found a significant association between EE and higher plasma cortisol profiles after Synacthen (p = 0.045). By contrast, OC was significantly associated with attenuated ACTH (p = 0.045), plasma cortisol (p = 0.005), and salivary cortisol (p = 0.023) concentrations following DEX-CRH. Results support the notion of altered HPA axis regulation in chronically work-stressed teachers, with differential patterns of hyper- and hyporeactivity depending on individual stress condition and the tested functional level of the HPA axis.
authors.affiliation: Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Wolfram
authors.forename: Silja
authors.initials: S
authors.lastname: Bellingrath
authors.forename: Nicolas
authors.initials: N
authors.lastname: Feuerhahn
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Kudielka
mesh_terms: D000324:Adrenocorticotropic Hormone; D000328:Adult; D002055:Burnout, Professional / Q000503:physiopathology* / Q000523:psychology; D002908:Chronic Disease; D003346:Corticotropin-Releasing Hormone; D003863:Depression / Q000523:psychology; D003907:Dexamethasone; D004644:Emotions / Q000502:physiology*; D005260:Female; D005858:Germany; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D005222:Mental Fatigue / Q000503:physiopathology* / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012574:Schools; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology; D013663:Teaching
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone