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Neurosci Biobehav Rev. 2010 Sep;35(1):97-103. doi: 10.1016/j.neubiorev.2009.12.011. Epub 2009 Dec 22.

The cortisol awakening response: more than a measure of HPA axis function.

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  • 1Psychophysiology and Stress Research Group, Department of Psychology, University of Westminster, London, UK. clowa@wmin.ac.uk

Abstract

In most healthy people morning awakening is associated with a burst of cortisol secretion: the cortisol awakening response (CAR). It is argued that the CAR is subject to a range physiological regulatory influences that facilitate this rapid increase in cortisol secretion. Evidence is presented for reduced adrenal sensitivity to rising levels of ACTH in the pre-awakening period, mediated by an extra-pituitary pathway to the adrenal from the suprachiasmatic nucleus (SCN). A role for the hippocampus in this pre-awakening regulation of cortisol secretion is considered. Attainment of consciousness is associated with 'flip-flop' switching of regional brain activation, which, it is argued, initiates a combination of processes: (1) activation of the hypothalamic pituitary adrenal (HPA) axis; (2) release of pre-awakening reduced adrenal sensitivity to ACTH; (3) increased post-awakening adrenal sensitivity to ACTH in response to light, mediated by a SCN extra-pituitary pathway. An association between the CAR and the ending of sleep inertia is discussed.

PMID:
20026350
[PubMed - indexed for MEDLINE]
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