Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus-pituitary-adrenal (HPA) axis responses to a low-dose ACTH1-24 (Synacthen) and dexamethasone-CRH test in healthy school teachers

Stress. 2013 Jan;16(1):54-64. doi: 10.3109/10253890.2012.683465. Epub 2012 May 16.

Abstract

Evidence for a detrimental impact of chronic work stress on health has accumulated in epidemiological research. Recent studies indicate altered hypothalamus-pituitary-adrenal (HPA) axis regulation as a possible biological pathway underlying the link between stress and disease. However, the direction of dysregulation remains unclear, with reported HPA hyper- or hyporeactivity. To disentangle potential effects on different functional levels in the HPA axis, we examined responses using two pharmacological stimulation tests in 53 healthy teachers (31 females, 22 males; mean age: 49.3 years; age range: 30-64 years): a low-dose adrenocorticotrophic hormone (ACTH(1-24), Synacthen) test was used to assess adrenal cortex sensitivity and the combined dexamethasone-corticotropin releasing hormone (DEX-CRH) test to examine pituitary and adrenal cortex reactivity. Blood and saliva samples were collected at - 1,+15,+30,+45,+60,+90,+120 min. Emotional exhaustion (EE), the core dimension of burnout, was measured with the Maslach Burnout Inventory. Overcommitment (OC) was assessed according to Siegrist's effort-reward-imbalance model. We found a significant association between EE and higher plasma cortisol profiles after Synacthen (p = 0.045). By contrast, OC was significantly associated with attenuated ACTH (p = 0.045), plasma cortisol (p = 0.005), and salivary cortisol (p = 0.023) concentrations following DEX-CRH. Results support the notion of altered HPA axis regulation in chronically work-stressed teachers, with differential patterns of hyper- and hyporeactivity depending on individual stress condition and the tested functional level of the HPA axis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenocorticotropic Hormone*
  • Adult
  • Burnout, Professional / physiopathology*
  • Burnout, Professional / psychology
  • Chronic Disease
  • Corticotropin-Releasing Hormone*
  • Depression / psychology
  • Dexamethasone*
  • Emotions / physiology*
  • Female
  • Germany
  • Humans
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Male
  • Mental Fatigue / physiopathology*
  • Mental Fatigue / psychology
  • Middle Aged
  • Neuropsychological Tests
  • Pituitary-Adrenal System / physiopathology*
  • Schools
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology
  • Teaching

Substances

  • Dexamethasone
  • Adrenocorticotropic Hormone
  • Corticotropin-Releasing Hormone