Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus–pituitary–adrenal (HPA) axis responses to a low-dose ACTH_1–24 (Synacthen) and dexamethasone–CRH test in healthy school teachers

Abstract

Evidence for a detrimental impact of chronic work stress on health has accumulated in epidemiological research. Recent studies indicate altered hypothalamus–pituitary–adrenal (HPA) axis regulation as a possible biological pathway underlying the link between stress and disease. However, the direction of dysregulation remains unclear, with reported HPA hyper- or hyporeactivity. To disentangle potential effects on different functional levels in the HPA axis, we examined responses using two pharmacological stimulation tests in 53 healthy teachers (31 females, 22 males; mean age: 49.3 years; age range: 30–64 years): a low-dose adrenocorticotrophic hormone (ACTH_1–24, Synacthen) test was used to assess adrenal cortex sensitivity and the combined dexamethasone–corticotropin releasing hormone (DEX–CRH) test to examine pituitary and adrenal cortex reactivity. Blood and saliva samples were collected at − 1,+15,+30,+45,+60,+90,+120 min. Emotional exhaustion (EE), the core dimension of burnout, was measured with the Maslach Burnout Inventory. Overcommitment (OC) was assessed according to Siegrist's effort–reward–imbalance model. We found a significant association between EE and higher plasma cortisol profiles after Synacthen (p = 0.045). By contrast, OC was significantly associated with attenuated ACTH (p = 0.045), plasma cortisol (p = 0.005), and salivary cortisol (p = 0.023) concentrations following DEX–CRH. Results support the notion of altered HPA axis regulation in chronically work-stressed teachers, with differential patterns of hyper- and hyporeactivity depending on individual stress condition and the tested functional level of the HPA axis.

Keywords::

• ACTH_1–24 (Synacthen) test
• chronic work stress
• dexamethasone–CRH test
• emotional exhaustion
• HPA axis regulation
• overcommitment

Acknowledgements

We would like to thank Heike Pieper and Prof. Dr. Norbert Wrobel for their support in medical questions and during data acquisition. This study was supported by Emmy Noether research grant KU 1401/4-1, KU 1401/4-2, and KU 1401/4-3 of the German Research Foundation (DFG) awarded to Brigitte M. Kudielka.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.