Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
In this Article
- What is stress?
- A brief history of stress
- What are the signs and symptoms of poorly managed stress?
- Who is most vulnerable to stress?
- Teen stress
- What is the healthy response to stress?
- How does the response to stress work?
- What is the role of the hypothalamus-pituitary-adrenal (HPA) axis (grouping) in stress?
- What is the role of the locus coeruleus in stress?
- How do the connections in the brain work in stress?
- What do we know about using (activating) and overusing our internal systems that respond to stress?
- What are the effects of stress on medical and psychological conditions?
- Conclusions about the effects of stress
- How can we manage stress?
- What's in the future for stress?
- Stress At A Glance
- Diet for Stress Management Slideshow
- Take the Stress Quiz!
- Tips for Exercise, Diet and Stress Reduction Slideshow
- Stress Rxlist FAQs
- Find a local Psychiatrist in your town
What is the role of the hypothalamus-pituitary-adrenal (HPA) axis (grouping) in stress?
The HPA axis is a grouping of responses to stress by the brain and the pituitary and adrenal glands. First, the hypothalamus (a central part of the brain) releases a compound called corticotrophin releasing factor (CRF), which was discovered in 1981. The CRF then travels to the pituitary gland, where it triggers the release of a hormone, adrenocorticotrophic hormone (ACTH). ACTH is released into the bloodstream and causes the cortex of the adrenal gland to release the stress hormones, particularly cortisol, which is a corticosteroid hormone. Cortisol increases the availability of the body's fuel supply (carbohydrate, fat, and glucose), which is needed to respond to stress. However, if cortisol levels remain elevated for too long, then muscle breaks down, there is a decreased inflammatory response, and suppression of the immune (defense) system occurs.
Because they suppress the immune system, corticosteroids in measured doses are used to treat many illnesses that are characterized by inflammation or an overactive immune system, such as asthma and inflammatory bowel disease. For the same reason, they are used to help reduce the chances that our body will immunologically reject a transplanted organ. Corticosteroids also can cause fluid retention and high blood pressure. Therefore, it is critical that the response to corticosteroids be carefully controlled (modulated). This control usually is accomplished by a feedback mechanism in which increased cortisol levels feeding back to the hypothalamus and pituitary turn off production of ACTH. In addition, extremely high levels of cortisol can cause mental changes, including depression and psychosis, which disappear when the levels return to normal.
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