The neuroendocrinology of stress and the importance of a proper balance between the mineralocorticoid and glucocorticoid receptors, 2024, Gold & Wong

(Guest Editorial)

No Abstract Provided — First two paragraphs

This editorial highlights two elegant articles published recently about the stress response in health and disease: Agorastos and Chrousos [1] and de Kloet and Joels [2]. Chrousos, the senior author of the first paper, is arguably the world’s foremost expert on the stress system organization and the consequences of its dysregulation.

The authors first define stress as a state of threatened homeostatic balance by a wide range of intrinsic or extrinsic, real or perceived challenges or stimuli. These are designated as stressors. This optimal homeostatic condition is maintained within a physiologic range by an extremely sophisticated stress system developed by living organisms, which influences energy redirection and multiple physiological adaptations to serve the organism’s self-regulation and adaptability. Repeated, short-lived, palpable stress states lead to adaptive responses and response habituations.

In contrast, inadequate aversive, excessive, or prolonged stress often produces pathological alterations in behavior and physiology that significantly diminish the quality of life and perturb multiple physiological systems, leading to sequala such as premature coronary artery disease, stroke, diabetes, and osteoporosis that significantly shorten life.

Neuroendocrine responses to stress are key components of the stress response. They result in hypo- or hyperactivity of the overall stress system response, including impaired glucocorticoid and mineralocorticoid receptor system signaling, ultimately promoting cumulative changes in allostatic load, which lead to clinically significant disturbances in behavior and physiology.

Agorastos and Chrousos’s article offers an expert and thorough overview of the organization and physiology of the human stress system and its reactivity, as well as the plethora of somatic effects of acute and chronic stress. It discusses a conceptual model of acute and chronic stress pathophysiology as a continuum in chronic disease development.

The authors present an exceptional, comprehensive review of the organization of the human stress system, thoroughly reviewing the roles of peripheral mediators and central structures such as the amygdala, locus coeruleus, various brain stem constituents, central and peripheral inflammatory mediators, and multiple target tissues that become dysregulated when the stress system runs awry. They provide excellent descriptions of acute stress syndrome and acute sickness syndrome and then offer a detailed overview of the pathophysiology of the stress response. This section includes a comprehensive overview of the physical, behavioral, and emotional effects of acute, traumatic, and chronic stress.

LINK (Nature)

 

"Craig provides many elegant lines of data on the critical role of the anterior insula in emotional awareness in many dimensions, including its cognitive components, as well as the influence of emotion in such domains as cognitions."

I didn't know data could be "elegant", I thought data was data.