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Cited by 5Child Abuse and TraumaStress Responses and CortisolChild Welfare and Adoption

Child Maltreatment and Psychopathology: A Brief Review on the Potential Role of the Hypothalamic-pituitary-adrenal Axis

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Ferrara, Pietro, Cammisa, Ignazio, Zona, Margherita, Pacucci, Ivana, Grimaldi, Maria Teresa, Scaltrito, Francesca, Giardino, Ida, Verrotti, Alberto +1 more·2025·Current Pediatric Reviews
DOI 10.2174/0115733963316599240704061209
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Abstract

Child maltreatment is a widespread global issue involving any form of harm or neglect by a parent or caregiver, leading to various forms of physical or emotional damage, with approximately 150 million affected children globally. This study discusses the potential mechanism of the hypothalamic-pituitary-adrenal axis dysfunction and cortisol hormone changes in linking child maltreatment to mental health disorders. It also discusses supportive strategies to prevent mental diseases and counteract the biological embedding of these conditions, emphasizing the need for comprehensive interventions to address the long-term impact of child maltreatment on mental health. Articles were selected using established methods previously described. Key information was obtained from scientific articles published during the past 20 years, including original studies, systematic reviews, and meta-analyses. Articles search was performed using top academic search engines. While research on hypothalamic-pituitary-adrenal axis response to stress in maltreated children is ongoing and far from conclusive, its impact and implications for physiological functioning and the predisposition to psychopathology are significant. Childhood maltreatment increases the risk of psychiatric illnesses, severity of diseases, and poor treatment responses. Childhood maltreatment manifests as disruptions to hypothalamic-pituitary-adrenal axis functioning, with the extent varying based on factors, such as the age of onset, parental responsiveness, and the type and characteristics of maltreatment. The complex interplay of these factors contributes to the diversity of hypothalamic-pituitary-adrenal axis responses to stress in maltreated children, creating a spectrum of physiological functioning and vulnerability to psychopathology.

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  • The hypothalamic-pituitary axis is uniquely vulnerable to TBI due to its anatomical and vascular characteristics, making pituitary cells-particularly somatotrophs and gonadotrophs-susceptible to ischemic, traumatic, and inflammatory damage.

    “The hypothalamic–pituitary axis (HPA) is uniquely vulnerable due to its anatomical and vascular characteristics, making pituitary cells—particularly somatotrophs and gonadotrophs—susceptible to ischemic, traumatic, and inflammatory damage.”

    From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [13]

  • The anterior pituitary's indirect, low-pressure vascular supply renders it especially susceptible to ischemia, shearing forces, and hypoxic injury.

    “This indirect, low-pressure vascular supply renders the anterior lobe especially susceptible to ischemia, shearing forces, and hypoxic injury, particularly in the setting of traumatic axonal injury, edema, or elevated intracranial pressure [11,12,13].”

    From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [13]

  • Anterior pituitary dysfunction is observed more frequently than posterior lobe involvement following pediatric TBI.

    “Dysfunction of the anterior pituitary is observed more frequently than involvement of the posterior lobe following pediatric traumatic brain injury, a discrepancy largely explained by differences in vascular anatomy and vulnerability to injury.”

    From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [13]

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Authors
Ferrara, P., Cammisa, I., Zona, M., Pacucci, I., Grimaldi, M. T., Scaltrito, F., Giardino, I., Verrotti, A., & Pettoello-Mantovani, M.
Affiliations
  • Università Campus Bio-Medico (IT)
  • Università Cattolica del Sacro Cuore (IT)
  • University of Foggia (IT)
  • University of Perugia (IT)
  • Italian Academy of Pediatrics, Milan, Italy
ORCID
Venue
Current Pediatric Reviews
Publisher
Bentham Science Publishers Ltd.
Published
2025-05
Volume
21
Issue
3
Pages
268-275
ISSN
1573-3963 (ISSN-L)
DOI
10.2174/0115733963316599240704061209
OpenAlex
W4401097797
Cited by
5
References
102
Citations by year
2026: 1 · 2025: 4
FWCI
0.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Pediatric Reviews (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Safety Research › Child Welfare and Adoption
Keywords
child abuse, hypothalamic-pituitary-adrenal axis, cortisol, psychopathology, childhood stress, biological embedding, parental responsiveness, maltreatment type, mental illness, stress response
MeSH terms
Mental Disorders, Child, Child Abuse, Humans, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Stress, Psychological

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