The hypothalamic-pituitary-adrenal axis and the female reproductive system
The hypothalamic-pituitary-adrenal axis and the female reproductive system
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DOI：
10.1111/j.1749-6632.1997.tb52128.x
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发表时间：
1997-01-01
期刊：
影响因子：
--
通讯作者：
Chrousos, GP
中科院分区：
文献类型：
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作者：
Magiakou, MA;Mastorakos, G;Chrousos, GP
下丘脑-垂体-肾上腺（HPA）轴和女性生殖系统相互交织并表现出复杂的关系。因此，HPA轴对生殖轴发挥深远的、主要是抑制性的作用，促肾上腺皮质激素释放激素（CRH）和CRH诱导的丙黑皮质素肽抑制下丘脑GnRH的分泌，糖皮质激素抑制垂体LH和卵巢雌激素和孕激素的分泌，并使雌激素靶组织（例如子宫内膜）对性腺类固醇具有抵抗力。 HPA轴的这些作用是导致压力、抑郁和饮食失调的“下丘脑”闭经以及库欣综合征的性腺功能减退的原因。相反，雌激素直接刺激CRH基因，这可能解释了女性轻度皮质醇亢进以及女性普遍患有抑郁、焦虑、饮食失调以及库欣病的原因。有趣的是，HPA 轴的几个组成部分及其受体存在于生殖组织中，作为其各种功能的自体调节剂。其中包括卵巢和子宫内膜 CRH，它们可能参与卵巢的炎症过程，即排卵和黄体溶解，以及子宫内膜的炎症过程，即着床和月经。最后，妊娠后半期的皮质醇增多症可以用血浆中胎盘 CRH 水平高来解释。这种皮质醇增多症会导致产后短暂的肾上腺抑制，这可能解释了这一时期的产后忧郁/抑郁和自身免疫现象。
The hypothalamic-pituitary-adrenal (HPA) axis and the female reproductive system are intertwined and exhibit a complex relationship. Thus, the HPA axis exerts profound, mostly inhibitory effects, on the reproductive axis, with corticotropin-releasing hormone (CRH) and CRH-induced propiomelanocortin peptides inhibiting hypothalamic GnRH secretion, and with glucocorticoids inhibiting pituitary LH and ovarian estrogen and progesterone secretion and rendering estrogen-target tissues, such as the endometrium, resistant to the gonadal steroid. These effects of the HPA axis are responsible for the" hypothalamic" amenorrhea of stress, depression and eating disorders, and the hypogonadism of Cushing's syndrome. Conversely, estrogen directly stimulates the CRH gene, which may explain the slight hypercortisolism of females and the preponderance of depressive, anxiety, and eating disorders, as well as Cushing's disease in women. Interestingly, several components of the HPA axis and their receptors are present in reproductive tissues, as autocoid regulators of their various functions. These include ovarian and endometrial CRH, which may participate in the inflammatory processes of the ovary, that is, ovulation and luteolysis, and of the endometrium, that is, implantation and menstruation. Finally, the hypercortisolism of the latter half of pregnancy can be explained by high levels of placenta CRH in plasma. This hypercortisolism causes a transient adrenal suppression in the postpartum period, which may explain the postpartum blues/depression and autoimmune phenomena of this period.