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Hypothalamic-Pituitary-Adrenal Axis Dysfunction in People With Cancer: A Systematic Review
Natalie G Kanter1, Sarah Cohen-Woods2,3,4, David A Balfour3
1College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
Cancer Medicine
|November 21, 2024
Summary
Cancer patients frequently exhibit hypothalamic-pituitary-adrenal (HPA) axis dysfunction, often with increased cortisol levels. Further research is needed to understand HPA dysregulation and improve patient care.
Area of Science:
- Endocrinology
- Oncology
- Neuroscience
Background:
- Cancer significantly impacts patient well-being, inducing psychological and physical stress.
- The hypothalamic-pituitary-adrenal (HPA) axis is central to the stress response, but its function in cancer patients is under-researched.
Approach:
- A systematic literature review analyzed case-control studies comparing HPA axis function in individuals with and without cancer.
- Searches were conducted across MEDLINE, PubMed, and Scopus databases up to May 2023.
Key Points:
- Seventeen studies revealed HPA axis dysfunction in cancer patients compared to controls.
- Most studies indicated increased baseline cortisol or hyperactive responses; some showed decreased or blunted responses.
- Observed HPA dysfunction occurred across diverse patient demographics, cancer stages, and treatments.
- Clinical outcomes linked to HPA dysfunction included fatigue, stress, cognitive issues, and sleep disturbances.
Conclusions:
- HPA axis dysfunction is prevalent in cancer patients.
- Increased baseline cortisol and heightened responses to stimulation were commonly reported.
- Standardized, well-powered studies are crucial to elucidate HPA dysregulation mechanisms and inform clinical management strategies.
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