The effect of stress on hypothylamic-pituitary-adrenal axis

Professor Evangelia Charmandari

Professor of Pediatrics – Pediatric and Adolescent Endocrinology
National and Kapodistrian University of Athens Medical School
First Department of Pediatrics, ‘Aghia Sophia’ Children’s Hospital

Stress activates the central and peripheral components of the stress system, i.e., the hypothalamic-pituitaryadrenal (HPA) axis and the arousal/sympathetic system. Appropriate responsiveness of the stress system to stressors is a crucial prerequisite for a sense of well-being, adequate performance of tasks and positive social interactions. By contrast, inappropriate responsiveness of the stress system may impair growth and development, and may account for a number of endocrine, metabolic, autoimmune and psychiatric disorders. The development and severity of these conditions primarily depend on the genetic vulnerability of the individual, the exposure to adverse environmental factors and the timing of the stressful event(s), given that prenatal life, infancy, childhood and adolescence are critical periods characterized by increased vulnerability to stressors.


11. Emmanouil CC, Pervanidou P, Charmandari E, Darviri C, Chrousos GP. The effectiveness of a health promotion and stress-management intervention program in a sample of obese children and adolescentsHormones (Athens). 2018; 17(3): 405-413.

10. Stefa A, Lamprokostopoulou A, Briana D, Kontogeorgou A, Papageorgiou I, Malamitsi-Puchner A, Tsitsilonis O, Gagos S, Charmandari EThe effect of intrauterine growth on leukocyte telomere length at birthJournal of Maternal-Fetal & Neonatal Medicine 2018; 6: 1-6.

9. Vardas K, Ilia S, Sertedaki A, Charmandari E, Briassouli E, Goukos D, Apostolou K, Psarra K, Botoula E, Tsagarakis S, Magira E, Routsi C, Stratakis CA, Nanas S, Briassoulis G. Increased glucocorticoid receptor expression in sepsis is related to heat shock proteins, cytokines, and cortisol and is associated with increased mortalityIntensive Care Medicine Experimental 2017; 5(1): 10.

8. Nicolaides NC, Charmandari E, Kino T, Chrousos GP. Stress-related and circadian secretion and target tissue actions of glucocorticoids: Impact on healthFrontiers in Endocrinology (Lausanne). 2017; 8:70.

7. Stavrou S, Nicolaides NC, Critselis E, Darviri C, Charmandari E, Chrousos GP. Paediatric stress: from neuroendocrinology to contemporary disordersEuropean Journal of Clinical Investigation 2017; 47(3): 262-269.

6. Markou A, Sertedaki A, Kaltsas G, Androulakis I, Marakaki C, Pappa T, Gouli A, Papanastasiou L, Fountoulakis S, Zacharoulis A, Karavidas A, Ragkou D, Charmandari E, Chrousos GP, Piaditis GP. Stress-induced aldosterone hypersecretion in a substantial subset of patients with essential hypertensionJournal of Clinical Endocrinology & Metabolism 2015; 100(8): 2857-64.

5.Nicolaides N, Kyratzi E, Lamprokostopoulou A, Chrousos G, Charmandari EStress, stress system and the role of glucocorticoidsNeuroimmunomodulation 2015; 22(1-2): 6-19.

4. Charmandari E, Achermann JC, Carel JC, Soder O, Chrousos GP. Stress response and child healthScience Signaling 2012; 5(248): mr1.

3.Chrousos GP, Kino T, Charmandari EEvaluation of the hypothalamic-pituitary-adrenal axis function in childhood and adolescenceNeuroimmunomodulation 2009; 16(5): 272-283.

2. Charmandari E, Tsigos C, Chrousos GP. Endocrinology of the stress response. Annual Reviews of Physiology 2005; 67: 259-284.

1. Charmandari E, Kino T, Souvatzoglou E, Chrousos GP. Pediatric stress: Hormonal mediators and stress responseHormone Research 2003; 59(4): 161-179.