title: Basal and stress-activated hypothalamic pituitary adrenal axis function in postmenopausal women with overactive bladder.
abstract: OBJECTIVE
  The aim of this study was to measure physiologic and psychologic stress reactivity in women with overactive bladder (OAB). There is growing evidence in preclinical models that central nervous system dysregulation, particularly in response to psychological stress, may contribute to lower urinary tract symptoms in women with OAB.
  
  
  METHODS
  Postmenopausal women with OAB and healthy controls underwent Structured Clinical Interview for DSM-IV Axis I disorders (SCID) to identify those without identifiable psychiatric disease. Eligible participants underwent physiologic measures including basal (cortisol-awakening response; CAR) and stress-activated salivary cortisol levels, heart rate (HR), urinary metanephrines and neurotrophins, as well as validated symptom assessment for stress, anxiety, depression, and bladder dysfunction at baseline and during, and following an acute laboratory stressor, the Trier Social Stress Test (TSST).
  
  
  RESULTS
  Baseline measures of cortisol reactivity measured by CAR showed blunted response among women with OAB (p = 0.015), while cortisol response to the TSST was greater in the OAB group (p = 0.019). Among OAB patients, bladder urgency as measured by visual analog scale (VAS) increased from pre- to post-TSST (p = 0.04). There was a main effect of TSST on HR (p < 0.001), but no group interaction.
  
  
  CONCLUSIONS
  Preliminary findings suggest that women with OAB have greater physiologic and psychologic stress reactivity than healthy controls. Importantly for women with OAB, acute stress appears to exacerbate bladder urgency. Evaluation of the markers of stress response may suggest targets for potential diagnostic and therapeutic interventions.
authors.affiliation: Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, 800 Walnut Street, 19th Floor, Philadelphia, PA, 19107, USA. Ariana.smith@uphs.upenn.edu.
authors.forename: Ariana L
authors.initials: AL
authors.lastname: Smith
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19107, USA.|Penn Center for the Study of Sex and Gender in Behavioral Health, Philadelphia, PA, 19107, USA.|Penn Center for Women's Behavioral Wellness, Philadelphia, PA, 19107, USA.
authors.forename: Liisa
authors.initials: L
authors.lastname: Hantsoo
authors.affiliation: Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Malykhina
authors.affiliation: Department of Mathematics & Computer Science, Muhlenberg College, Allentown, PA, 18104, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: File
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Valentino
authors.affiliation: Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, 800 Walnut Street, 19th Floor, Philadelphia, PA, 19107, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wein
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19107, USA.|Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19107, USA.|Penn Center for the Study of Sex and Gender in Behavioral Health, Philadelphia, PA, 19107, USA.|Penn Center for Women's Behavioral Wellness, Philadelphia, PA, 19107, USA.
authors.forename: C Neill
authors.initials: CN
authors.lastname: Epperson
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000368:Aged; D001007:Anxiety / Q000503:physiopathology; D016022:Case-Control Studies; D003863:Depression / Q000503:physiopathology; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D017698:Postmenopause / Q000502:physiology / Q000523:psychology*; D013315:Stress, Psychological / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000503:physiopathology* / Q000523:psychology
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; Hypothalamic–pituitary–adrenal axis; Overactive bladder; Stress