Dissociation of ACTH and glucocorticoids

Stefan R. Bornstein, William C. Engeland, Monika Ehrhart-Bornstein, James P. Herman

Research output: Contribution to journalReview articlepeer-review

262 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)175-180
Number of pages6
JournalTrends in Endocrinology and Metabolism
Issue number5
StatePublished - Jul 2008

Bibliographical note

Funding Information:
Supported by grants NSF IOB-0548584 (W.C.E.), MH049698 (J.P.H.), MH069725 (J.P.H.), MH069680 (J.P.H.), AG12962 (J.P.H.), DFG Collaborative Research Centre Dresden (SFB 655-A6; M.E.B. and S.R.B.). Figure 1 was produced using SERVIER Medical Art.


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