Hypothalamus-pituitary-adrenal (HPA) axis, chronic stress, hair cortisol, metabolic syndrome and mindfulness

Over the past 60 years, there has been an exponential expansion in the field of neuroendocrinology. The HPA Axis (Hypothalamus Pituitary Adrenal Axis) is affected by both internal physiological stressors (cytokines, hypoxia, macromolecules etc) and by external stressors (source of anxiety, fear etc.) which threaten the organisms homeostasis. Cortisol binds to cortisol receptors throughout the body. The hormone receptor complex is to be found in the nucleus of the cells, where it binds to DNA (docking) (Figure 3).The consequences of this bond vary considerably. In some cells cortisol can induce some genes and repress others. In cases where the HPA Axis is overactive the amount of cortisol in the nucleus of the cells may increase by approximately tenfold. There is good evidence over the past years of dysfunction of the HPA Axis in Major Depression. Nemeroff [1] has suggested that the assessment of the HPA Axis activity may be a useful tool in clinical practice. Prof. Nemeroff [1], has emphasised the opportunity of “early intervention in at risk individuals”. Prof. Nemeroff suggests that individuals who have been exposed to untoward early life stress can be considered an “at risk population” [1]. There is emerging evidence showing the usefulness of Hair Cortisol analysis as an indicator of sub-acute and chronic stress [2]. Can we use Hair Cortisol levels prophylactically in Primary Care to assess HPA Axis activity in individuals at risk? Can we use Hair Cortisol to monitor response to treatment in clinical practice in an effort to provide more effective personalised care?.