title: Updates in the neuroendocrinology of stress and its clinical management.
abstract: OBJECTIVE
  This review will provide updates on the neurobiology of stress, with specific focus on the transmitting mechanism of stress, the intricacies of integrating stress-related information, variability in response to stressors and clinical interventions.
  
  
  RESULTS
  Neuropeptides have been implicated as a potential modulator for pathological stress via effects on neurogenesis, alterations in functional states of the cortico-limbic circuits and possible neuroprotection. Glucocorticoid receptors and mineralocorticoid receptors have been implicated in limbic modulation of stress and changes in the hypothalamic pituitary adrenal axis activity via corticosteroid signalling and feedback regulation. Chronic stress and genetic susceptibility have been found to promote intracellular mitochondrial and cellular DNA damage resulting in structural and functional alterations of neuroanatomy and neural circuitries.
  
  
  CONCLUSIONS
  The interplay of stress and the neuroendocrine system appears to be influenced by alterations in genetic expression, resulting in neurochemical messenger and inflammatory cytokine alterations that impact neuroanatomy and neural circuitries to affect both central nervous system structure and function. These neurobiological contributions have been alluded to as possible contributors to stress-related psychopathologies. Clinical interventions with psychotropics, mind body therapies and behavioural therapies have been found to attenuate and reverse stress-related responses.
authors.affiliation: Massachusetts General Hospital, Gregory Fricchione, MD Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Nadia
authors.initials: N
authors.lastname: Quijije
mesh_terms: D000818:Animals; D001921:Brain / Q000378:metabolism*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D009479:Neuropeptides / Q000378:metabolism*; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D013315:Stress, Psychological / Q000378:metabolism* / Q000628:therapy*
chemical_list: D009479:Neuropeptides