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Endocrine and immunological aspects of burnout: a narrative review

Review article
Authors Ingibjörg H Jonsdottir
A. S. Dahlman
Published in European Journal of Endocrinology
Volume 180
Issue 3
Pages R147-R158
ISSN 0804-4643
Publication year 2019
Published at Department of Food and Nutrition, and Sport Science
Pages R147-R158
Language en
Keywords cortisol awakening response, acute psychosocial stress, coronary-heart-disease, dhea-s response, diurnal cortisol, clinical, burnout, work stress, hpa axis, exhaustion, risk, Endocrinology & Metabolism
Subject categories Endocrinology


Burnout has several different definitions, and attempts have been made to discriminate between burnout as a psychological construct and burnout as a clinical entity. A large body of research has focused on elucidating the biological link between stress exposure and burnout and/or finding a clinically usable biomarker for burnout. The objective of this narrative review is to summarize the main end ocrine and immune findings in relation to burnout. The literature has primarily focused on dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. However, albeit the large body of studies, it cannot be concluded that clear effects are seen on HPA axis function in people with burnout. The HPA axis and anabolic acute reactivity to stress might be affected in clinical burnout. Plausible, effects of chronic stress might rather be seen when measuring responses to acute stress rather than resting state hormonal levels. Studies on other hormones, including thyroid hormones, prolactin and growth hormone in burnout subjects are inconclusive. It is important to note that this field is faced with many methodological challenges, one being the diurnal and pulsatile nature of many of the hormones of interest, including cortisol, which is not always considered. Another challenge is the heterogeneity regarding definitions and measurements of stress and burnout. Existing studies on burnout and immune function are heterogeneous regarding the results and no firm conclusion can be made if clinically relevant immune changes are present in burnout subjects. An overall conclusion is that existing research cannot confirm any homogenous reliable endocrinological or immunological changes related to burnout.

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