Cited by 1,819Stress Responses and CortisolAdrenal Hormones and DisordersNeuropeptides and Animal Physiology

Regulation of the Hypothalamic‐Pituitary‐Adrenocortical Stress Response

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Herman, James P., McKlveen, Jessica M., Ghosal, Sriparna, Kopp, Brittany, Wulsin, Aynara, Makinson, Ryan, Scheimann, Jessie, Myers, Brent·2016·Comprehensive Physiology

Abstract

The hypothalamo‐pituitary‐adrenocortical (HPA) axis is required for stress adaptation. Activation of the HPA axis causes secretion of glucocorticoids, which act on multiple organ systems to redirect energy resources to meet real or anticipated demand. The HPA stress response is driven primarily by neural mechanisms, invoking corticotrophin releasing hormone (CRH) release from hypothalamic paraventricular nucleus (PVN) neurons. Pathways activating CRH release are stressor dependent: reactive responses to homeostatic disruption frequently involve direct noradrenergic or peptidergic drive of PVN neurons by sensory relays, whereas anticipatory responses use oligosynaptic pathways originating in upstream limbic structures. Anticipatory responses are driven largely by disinhibition, mediated by trans‐synaptic silencing of tonic PVN inhibition via GABAergic neurons in the amygdala. Stress responses are inhibited by negative feedback mechanisms, whereby glucocorticoids act to diminish drive (brainstem) and promote transsynaptic inhibition by limbic structures (e.g., hippocampus). Glucocorticoids also act at the PVN to rapidly inhibit CRH neuronal activity via membrane glucocorticoid receptors. Chronic stress‐induced activation of the HPA axis takes many forms (chronic basal hypersecretion, sensitized stress responses, and even adrenal exhaustion), with manifestation dependent upon factors such as stressor chronicity, intensity, frequency, and modality. Neural mechanisms driving chronic stress responses can be distinct from those controlling acute reactions, including recruitment of novel limbic, hypothalamic, and brainstem circuits. Importantly, an individual's response to acute or chronic stress is determined by numerous factors, including genetics, early life experience, environmental conditions, sex, and age. The context in which stressors occur will determine whether an individual's acute or chronic stress responses are adaptive or maladaptive (pathological). © 2016 American Physiological Society. Compr Physiol 6:603‐621, 2016.

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  • The HPA axis is the principal neuroendocrine pathway through which stress alters immune responses, mainly via glucocorticoid secretion.

    “The hypothalamic–pituitary–adrenal (HPA) axis constitutes the principal neuroendocrine pathway through which stress alters immune responses, mainly via glucocorticoid secretion [4,5].”

    From Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation (2025) · cites this paper as [4]

    The Introduction (page not available) says stress-level glucocorticoids affect inflammation, and the Chronic Stress section describes effects on glucocorticoid-sensitive immune organs. The paper supports an HPA–glucocorticoid route by which stress can affect immunity, but does not establish that it is the principal neuroendocrine pathway for altering immune responses. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Trauma, attachment insecurity, and stress dysregulation both contribute to and result from abusive dynamics.

    “Moreover, integrating psychological and neurobiological perspectives highlights how trauma, attachment insecurity, and stress dysregulation both contribute to and result from abusive dynamics (Herman et al., 2016; González-Acosta et al., 2021).”

    From From use to abuse: psychological, neurobiological, and spiritual pathways in relational harm and recovery (2026) · cites this paper as Herman et al., 2016

    The Chronic Stress > Modality and Severity passage describes aggressive interactions among rats and altered HPA-axis responses in submissive animals. The Perspective also links early adversity to later stress reactivity. Neither passage establishes that trauma or attachment insecurity both contributes to and results from abusive dynamics, or that stress dysregulation has that bidirectional relationship. No page numbers are supplied in our copy. (LLM, conf=0.86)

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  • Prolonged exposure to emotional abuse constitutes a chronic stressor that persistently activates the HPA axis, resulting in dysregulated cortisol secretion.

    “Prolonged exposure to emotional abuse constitutes a chronic stressor that persistently activates the hypothalamic–pituitary–adrenal (HPA) axis, resulting in dysregulated cortisol secretion–the primary glucocorticoid involved in stress regulation (Herman et al., 2016).”

    From From use to abuse: psychological, neurobiological, and spiritual pathways in relational harm and recovery (2026) · cites this paper as Herman et al., 2016

    The Chronic Stress section says repeated or prolonged stress can produce long-lasting changes in HPA function and increased cumulative glucocorticoid exposure. It does not specifically identify emotional abuse or establish persistent HPA activation and dysregulated cortisol secretion as its outcome; it says responses vary with the stressor and may habituate. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Neurobiological embedding of trauma explains why individuals subjected to prolonged emotional abuse often experience enduring psychological distress and face challenges in achieving recovery even after cessation of overt abuse.

    “This neurobiological embedding of trauma helps explain why individuals subjected to prolonged emotional abuse often experience enduring psychological distress and face challenges in achieving recovery even after the cessation of overt abuse (Herman et al., 2016; Teicher et al., 2016).”

    From From use to abuse: psychological, neurobiological, and spiritual pathways in relational harm and recovery (2026) · cites this paper as Herman et al., 2016

    The Chronic Stress section (page not provided) says prolonged stress can produce long-lasting changes in HPA function, and its Neurocircuit Mechanisms section links chronic stress with PTSD and depression. It does not specifically address prolonged emotional abuse in people or establish that psychological distress and difficulty recovering persist after the abuse ends. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Prolonged abuse disrupts neural connectivity, particularly between the prefrontal cortex and limbic structures, leading to inefficient top-down regulation of emotional responses.

    “At a systems level, prolonged abuse disrupts neural connectivity, particularly between the prefrontal cortex and limbic structures, leading to inefficient top-down regulation of emotional responses.”

    From From use to abuse: psychological, neurobiological, and spiritual pathways in relational harm and recovery (2026) · cites this paper as Herman et al., 2016

    The ‘falling’ phase section (page unavailable) describes prefrontal inhibition of stress responses, and the Chronic Stress neurocircuit section describes altered recruitment of prefrontal regions during chronic stress. Neither establishes that prolonged abuse disrupts prefrontal–limbic connectivity or that such disruption causes inefficient top-down regulation of emotions. (LLM, conf=0.85)

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Research works printed but not linked: 1

  1. [75]Herman JP Figueiredo HF Mueller NK Ostrander MM Zhang R Tauchi M Choi DC Furay AR Evanson NK Nelson EB Ulrich-Lai YM Neurochemical Systems Regulating the Hypothalamo-Pituitary-Adrenocortical Axis Handbook of neurochemistry and molecular neurobiology Behavioral neurochemistry, neuroendocrinology, and molecular neurobiology Blaustein J Lajtha A New York Springer 2007 xiv 954

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Authors
Herman, J. P., McKlveen, J. M., Ghosal, S., Kopp, B., Wulsin, A., Makinson, R., Scheimann, J., & Myers, B.
Affiliations
University of Cincinnati (US)
Corresponding author
Herman, James P.
Venue
Comprehensive Physiology
Publisher
Wiley
Published
2016-03-15
Volume
6
Issue
2
Pages
603-621
ISSN
2040-4603 (ISSN-L)
OpenAlex
W2413515606
Cited by
1,819
References
180
Citations by year
2026: 115 · 2025: 220 · 2024: 309 · 2023: 277 · 2022: 238 · 2021: 199 · 2020: 174 · 2019: 124 · 2018: 92 · 2017: 60 · 2016: 11
Type
other
Language
en
Open access
Locations
  • Comprehensive physiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01MH101729, R01MH049698, R01MH069860)
  • National Institute of Neurological Disorders and Stroke (F30NS095578, T32NS007453)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuropeptides and Animal Physiology
Keywords
hypothalamic-pituitary-adrenal axis, stress response, corticotropin-releasing factor, paraventricular nucleus, glucocorticoid negative feedback, amygdala, hippocampus, chronic stress, anticipatory stress, noradrenergic activation, GABAergic inhibition, limbic system, stress adaptation
MeSH terms
Animals, Glucocorticoids, Homeostasis, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Stress, Physiological

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