The Hypothalamic-Pituitary-Adrenal Axis and Immune-Mediated Inflammation

doi:10.1056/NEJM199505183322008

Volume 332:1351-1363		May 18, 1995		Number 20

The Hypothalamic–Pituitary–Adrenal Axis and Immune-Mediated Inflammation

George P. Chrousos, M.D.

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Celsus described four of the five cardinal signs of inflammation2000 years ago, and Eustachio discovered the adrenal glandsalmost 500 years ago, but not until 1936 did Selye note thatin rats exposed to stressors, the adrenal glands were enlarged,and the thymus and lymph nodes shrunken.¹^,²^,³ Cortisone, theactive principle of the adrenal glands, was isolated by Kendalland Reichstein in the late 1940s and shown to suppress immuneorgans. These scientists, along with Hench, received the NobelPrize in Physiology and Medicine, after Hench and colleaguesshowed that cortisone could ameliorate rheumatoid arthritis.⁴^,⁵

In recent years, our . . . [Full Text of this Article]

The Hypothalamic–Pituitary–Adrenal Axis

The Immune-Mediated Inflammatory Reaction

Effects of the HPA Axis on the Immune-Mediated Inflammatory Reaction

Adrenocortical Hormones

Pituitary Hormones

Hypothalamic Hormones

Effects of Immune-Mediated Inflammatory Reactions on the HPA Axis

Interactions between the HPA Axis and Immune-Mediated Inflammation

Short- and Long-Term Adaptations

Influences of Reproductive Hormones

Disturbances in the Interaction between the HPA Axis and Immune-Mediated Inflammation

Defects of the HPA Axis

Defects of the Glucocorticoid Target Tissues

Therapeutic Perspectives

Discussion

Source Information

From the Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bldg. 10, Rm. 10N262, Bethesda, MD 20892, where reprint requests should be addressed to Dr. Chrousos.

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