Evaluation of the hypothalamic-pituitary-adrenal axis function in childhood and adolescence

Neuroimmunomodulation. 2009;16(5):272-83. doi: 10.1159/000216185. Epub 2009 Jun 29.


The hypothalamic-pituitary-adrenal (HPA) axis plays an important role in the maintenance of basal and stress-related homeostasis. The hypothalamus controls the secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary, which in turn stimulates the secretion of glucocorticoids from the adrenal cortex. Glucocorticoids, the final effectors of the HPA axis, regulate a broad spectrum of physiologic functions essential for life and exert their effects through their ubiquitously distributed intracellular receptors. Alterations in the activity of the HPA axis may present with symptoms and signs of glucocorticoid deficiency or excess. Detailed endocrinologic evaluation is of primary importance in determining the diagnosis and/or etiology of the underlying condition. We review the most common endocrinologic investigations used in the evaluation of the HPA axis integrity and function.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Child
  • Clinical Laboratory Techniques / standards
  • Clinical Laboratory Techniques / trends
  • Diagnostic Techniques, Endocrine / standards
  • Diagnostic Techniques, Endocrine / trends*
  • Endocrine System Diseases / diagnosis*
  • Endocrine System Diseases / physiopathology
  • Glucocorticoids / analysis
  • Glucocorticoids / metabolism*
  • Humans
  • Hypothalamic Hormones / analysis
  • Hypothalamic Hormones / metabolism
  • Hypothalamo-Hypophyseal System / growth & development
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Neurosecretory Systems / growth & development
  • Neurosecretory Systems / physiopathology*
  • Pituitary-Adrenal Function Tests / methods
  • Pituitary-Adrenal Function Tests / standards
  • Pituitary-Adrenal Function Tests / trends
  • Pituitary-Adrenal System / growth & development
  • Pituitary-Adrenal System / physiopathology*


  • Glucocorticoids
  • Hypothalamic Hormones