A hormone-based characterization and taxonomy of stress: possible usefulness in management

"Stress" is being increasingly implicated in the pathogenesis of a variety of psychological and somatic disturbances. Because responses to stress can vary widely, the absence of a suitable, pathophysiologically based taxonomy of stress responses has hindered physicians in their efforts to devise treatments tailored to deal with specific stress-related problems. It is proposed herein that classical endocrinologic criteria be employed to characterize stress responses in terms of the associated hormonal secretion ratios and their temporal evolution. Ratios of the responses to stressors of the sympathoadrenal system (SA) and the hypothalamo-pituitary-adrenal (HPA) axis can be either unity (ratio = 1) or dissociated in varying degree, with SA or HPA dominance and for more or less prolonged periods. Published reports of studies in both laboratory animals and patients with stress-associated illnesses (eg, post-traumatic stress disorder [PTSD]) suggest that such hormone-secretion ratios together with their temporal patterns can be used to characterize the particular stress response under examination, thereby providing strong support for further study of the proposed taxonomy. Such a classification of responses to stress stimuli will make it possible to test the overall concept by establishing a correspondence between the suggested hormonal profile and the associated clinical/psychological picture, as well as enable assessment of the benefit of a therapeutic strategy designed to fit the particular category of stress response exhibited by the patient.