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Hypothalamic‐Pituitary‐Adrenal (HPA) Axis and Aging

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Human aging is associated with increasing frailty and morbidity which can result in significant disability. Dysfunction of the hypothalamic‐pituitary‐adrenal (HPA) axis may contribute to aging‐related diseases like depression, cognitive deficits, and Alzheimer's disease in some older individuals. In addition to neuro‐cognitive dysfunction, it has also been associated with declining physical performance possibly due to sarcopenia. This article reviews the pathophysiology of HPA dysfunction with respect to increased basal adrenocorticotropic hormone (ACTH) and cortisol secretion, decreased glucocorticoid (GC) negative feedback at the level of the paraventricular nucleus (PVN) of the hypothalamus, hippocampus (HC), and prefrontal cortex (PFC), and flattening of diurnal pattern of cortisol release. It is possible that the increased cortisol secretion is secondary to peripheral conversion from cortisone. There is a decline in pregnolone secretion and C‐19 steroids (DHEA) with aging. There is a small decrease in aldosterone with aging, but a subset of the older population have a genetic predisposition to develop hyperaldosteronism due to the increased ACTH stimulation. The understanding of the HPA axis and aging remains a complex area with conflicting studies leading to controversial interpretations. © 2014 American Physiological Society. Compr Physiol 4:1495‐1510, 2014.

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Figure 1. Figure 1. Normal HPA axis.
Figure 2. Figure 2. Glucocorticoid receptors.
Figure 3. Figure 3. Effects of aging on the rodent hypothalamic‐pituitary‐adrenal axis.
Figure 4. Figure 4. Effects of elevated cortisol levels that can accelerate the aging process.
Figure 5. Figure 5. The effect of aging on basal adrenal steroid hormones.
Figure 6. Figure 6. Hypothesis: Cortisol increase in older persons is due to conversion of cortisone to cortisol in adipose tissue.

Figure 1. Normal HPA axis.

Figure 2. Glucocorticoid receptors.

Figure 3. Effects of aging on the rodent hypothalamic‐pituitary‐adrenal axis.

Figure 4. Effects of elevated cortisol levels that can accelerate the aging process.

Figure 5. The effect of aging on basal adrenal steroid hormones.

Figure 6. Hypothesis: Cortisol increase in older persons is due to conversion of cortisone to cortisol in adipose tissue.
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Deepashree Gupta, John E. Morley. Hypothalamic‐Pituitary‐Adrenal (HPA) Axis and Aging. Compr Physiol 2014, 4: 1495-1510. doi: 10.1002/cphy.c130049