Top

Sports Medicine - Open

Published in:

Open Access 01-12-2017 | Original Research Article

Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)—EROS-HPA Axis

Authors: Flavio A. Cadegiani, Claudio E. Kater

Published in: Sports Medicine - Open | Issue 1/2017

Abstract

Background

Overtraining syndrome (OTS) results from excessive training load without adequate recovery and leads to decreased performance and fatigue. The pathophysiology of OTS in athletes is not fully understood, which makes accurate diagnosis difficult. Previous studies indicate that alterations in the hypothalamus-pituitary-adrenal (HPA) axis may be responsible for OTS; however, the data is not conclusive. This study aimed to compare, through gold standard and exercise-independent tests, the response of the HPA axis in OTS-affected athletes (OTS group) to healthy physically active subjects (ATL group) and healthy non-active subjects (NCS group).

Methods

Selected subjects were evaluated for cortisol response to a 250-μg cosyntropin stimulation test (CST), cortisol and adrenocorticotropic hormone (ACTH) responses during an insulin tolerance test (ITT), and salivary cortisol rhythm (SCR).

Results

A total of 51 subjects were included (OTS, n = 14; ATL, n = 25; and NCS, n = 12). Cortisol response in the CST was similar among the three groups. Conversely, mean cortisol response during an ITT was significantly higher in ATL (21.7 μg/dL; increase = 9.2 μg/dL) compared to OTS (17.9 μg/dL; 6.3 μg/dL) and NCS (16.9 μg/dL; 6.0 μg/dL) (p ≤ 0.001; p = 0.01). Likewise, median ACTH response during an ITT was significantly higher in ATL (91.4 pg/mL; increase = 45.1 pg/mL) compared to OTS (30.3 pg/mL; 9.7 pg/mL) and NCS (51.4 pg/mL; 38.0 pg/mL) (p = 0.006; p = 0.004). For SCR, mean cortisol 30 min after awakening was significantly higher in ATL (500 ng/dL) compared to OTS (323 ng/dL) and NCS (393 ng/dL) (p = 0.004). We identified the following cutoffs that could help exclude or confirm OTS: cortisol level at 30 min after awakening (exclusion = > 530 ng/dL); cortisol response to ITT (exclusion = > 20.5 μg/dL; confirmation = < 17 μg/dL or increase < 9.5 μg/dL); and ACTH response (exclusion = > 106 pg/mL or increase > 70 pg/mL; confirmation = < 35 pg/mL and increase < 14.5 pg/mL).

Conclusion

The findings of the present study showed that healthy athletes disclose adaptions to exercises that helped improve sport-specific performance, whereas this sort of hormonal conditioning was at least partially lost in OTS, which may explain the decrease in performance in OTS.

Meeusen R, Duclos M, Foster C, Fry A, Gleeson M, Nieman D, Raglin J, Rietjens G, Steinacker J, Urhausen A, European College of Sport Science; American College of Sports Medicine. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc. 2013 Jan;45(1):186–205.CrossRefPubMed

Le Meur Y, Hausswirth C, Natta F, et al. A multidisciplinary approach to overreaching detection in endurance trained athletes. J Appl Physiol. 1 February 2013;114(3):411–20.CrossRefPubMed

Nederhof E, Zwerver J, Brink M, Meeusen R, Lemmink K. Different diagnostic tools in nonfunctional overreaching. Int J Sports Med. 2008 Jul;29(7):590–7.CrossRefPubMed

Lehmann M, Foster C, Keul J. Overtraining in endurance athletes: a brief review. Med Sci Sports Exerc. 1993;25(7):854–62.CrossRefPubMed

Cadegiani FA, Kater CE. Hormonal aspects of overtraining syndrome: a systematic review. BMC Sports Sci Med Rehabil. 2017 Aug 2;9:14.CrossRefPubMedPubMedCentral

Thiel C, Vogt L, Bürklein M, Rosenhagen A, Hübscher M, Banzer W. Functional overreaching during preparation training of elite tennis professionals. J Hum Kinet. 2011 Jun;28:79–89.CrossRefPubMedPubMedCentral

Meeusen R, Nederhof E, Buyse L, Roelands B, De Schutter G, Piacentini MF. Diagnosing overtraining in athletes using the two-bout exercise protocol. Br J Sports Med. 2010;44(9):642–8.CrossRefPubMed

Meeusen R, Piacentini MF, Busschaert B, Buyse L, De Schutter G, Stray-Gundersen J. Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status. Eur J Appl Physiol. 2004 Mar;91(2–3):140–6.CrossRefPubMed

Urhausen A, Gabriel HH, Kindermann W. Impaired pituitary hormonal response to exhaustive exercise in overtrained endurance athletes. Med Sci Sports Exerc. 1998 Mar;30(3):407–14.CrossRefPubMed

10.

Barron G, Noakes T, Levy W, Smidt C, Millar R. Hypothalamic dysfunction in overtrained athletes. J Clin Endocrinol Metab. 1985;60:803–6. Cizza G, Kvetnansky R, Tartaglia M, Blackman M, Chrousos G,CrossRefPubMed

11.

Gold P. Immobolisation stress rapidly decreases hypothalamic corticotropin-releasing hormone secretion in vitro in the male 344/N Fischer rat. Life Sci. 1993;53:233–40.CrossRefPubMed

12.

Duclos M, Corcuff J-B, Arsac L, et al. Corticotroph axis sensitivity after exercise in endurance-trained athletes. Clin Endocrinol. 1998;8:493–501.CrossRef

13.

Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016 Aug 24;16(1):48.CrossRefPubMedPubMedCentral

14.

Ryan R, Booth S, Spathis A, Mollart S, Clow A. Use of salivary diurnal cortisol as an outcome measure in randomised controlled trials: a systematic review. Ann Behav Med. 2016 Apr;50(2):210–36.CrossRefPubMedPubMedCentral

15.

Stalder T, Kirschbaum C, Kudielka BM. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016 Jan;63:414–32.CrossRefPubMed

16.

Oosterholt BG, Maes JH, Van der Linden D, Verbraak MJ, Kompier MA. Burnout and cortisol: evidence for a lower cortisol awakening response in both clinical and non-clinical burnout. J Psychosom Res. 2015 May;78(5):445–51.CrossRefPubMed

17.

Powell DJ, Liossi C, Moss-Morris R, Schlotz W. Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis. Psychoneuroendocrinology. 2013 Nov;38(11):2405–22.CrossRefPubMed

18.

Slivka DR, Hailes WS, Cuddy JS, Ruby BC. Effects of 21 days of intensified training on markers of overtraining. J Strength Cond Res. 2010 Oct;24(10):2604–12.CrossRefPubMed

19.

Rietjens GJ, Kuipers H, Adam JJ, et al. Physiological, biochemical and psychological markers of strenuous training-induced fatigue. Int J Sports Med. 2005 Jan-Feb;26(1):16–26.CrossRefPubMed

20.

Coutts AJ, Reaburn P, Piva TJ, Rowsell GJ. Monitoring for overreaching in rugby league players. Eur J Appl Physiol. 2007 Feb;99(3):313–24.CrossRefPubMed

21.

Schmikli SL, de Vries WR, Brink MS, Backx FJ. Monitoring performance, pituitary-adrenal hormones and mood profiles: how to diagnose non-functional over-reaching in male elite junior soccer players. Br J Sports Med. 2012 Nov;46(14):1019–23.CrossRefPubMed

22.

Tanskanen MM, Kyröläinen H, Uusitalo AL, Huovinen J, Nissilä J, Kinnunen H, Atalay M, Häkkinen K. Serum sex hormone-binding globulin and cortisol concentrations are associated with overreaching during strenuous military training. J Strength Cond Res. 2011 Mar;25(3):787–97.CrossRefPubMed

23.

Kraemer WJ, French DN, Paxton NJ. Changes in exercise performance and hormonal concentrations over a big ten soccer season in starters and nonstarters. J Strength Cond Res. 2004 Feb;18(1):121–8.PubMed

24.

Hug M, Mullis PE, Vogt M, Ventura N, Hoppeler H. Training modalities: over-reaching and over-training in athletes, including a study of the role of hormones. Best Pract Res Clin Endocrinol Metab. 2003 Jun;17(2):191–209.CrossRefPubMed

25.

Steinacker JM, Lormes W, Kellmann M, et al. Training of junior rowers before world championships. Effects on performance, mood state and selected hormonal and metabolic responses. J Sports Med Phys Fitness. 2000 Dec;40(4):327–35.PubMed

26.

Fry AC, Kraemer WJ, Ramsey LT. Pituitary-adrenal-gonadal responses to high-intensity resistance exercise overtraining. J Appl Physiol (1985). 1998 Dec;85(6):2352–9.

27.

Fry RW, Morton AR, Garcia-Webb P, Crawford GP, Keast D. Biological responses to overload training in endurance sports. Eur J Appl Physiol Occup Physiol. 1992;64(4):335–44.CrossRefPubMed

28.

Lehmann M, Gastmann U, Petersen KG, Bachl SA, Khalaf AN, Fischer S, Keul J. Training-overtraining: performance, and hormone levels, after a defined increase in training volume versus intensity in experienced middle- and long-distance runners. Br J Sports Med. 1992 December;26(4):233–42.CrossRefPubMedPubMedCentral

29.

O'Connor PJ, Morgan WP, Raglin JS, Barksdale CM, Kalin NH. Mood state and salivary cortisol levels following overtraining in female swimmers. Psychoneuroendocrinology. 1989;14(4):303–10.CrossRefPubMed

30.

Barron LJ, Noakes TD, Levy W, Smith C, Millar RP. Hypothalamic dysfunction in overtrained athletes. J Clin Endocrinol Metab. 1985;60(4):803–6.CrossRefPubMed

31.

Cadegiani FA, Kater CE. Rationale, design, material, methods, subject selection and baseline characteristics of the Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study. Available at: https://osf.io/bhpq9/.

32.

Ospina NS, Al Nofal A, Bancos I, Javed A, Benkhadra K, Kapoor E, et al. ACTH stimulation tests for the diagnosis of adrenal insufficiency: systematic review and meta-analysis. J Clin Endocrinol Metab. 2016;101(2):427–34.CrossRefPubMed

33.

Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364–89.CrossRefPubMed

34.

Roberts AC, McClure RD, Weiner RI, Brooks GA. Overtraining affects male reproductive status. Fertil Steril. 1993 Oct;60(4):686–92.CrossRefPubMed

35.

Bae YJ, Kratzsch J. Corticosteroid-binding globulin: modulating mechanisms of bioavailability of cortisol and its clinical implications. Best Pract Res Clin Endocrinol Metab. 2015 Oct;29(5):761–72.CrossRefPubMed

36.

Perogamyros I, Aarons L, Miller AG, Trainer PJ, Ray DW. Corticosteroid-binding globulin regulates cortisol pharmacokinetics. Clin Endocrinol. 2011 Jan;74(1):30–6.CrossRef

37.

Brooks K, Carter J. Overtraining, exercise and adrenal insufficiency. J Nov Physiother. 2013;3(125).

38.

Angeli A, Minetto M, Dovio A, Paccotti P. The overtraining syndrome in athletes: a stress-related disorder. J Endocrinol Investig. 2004;27(6):603–12.CrossRef

39.

Urhausen A, Gabriel H, Kindermann W. Blood hormones as markers of training stress and overtraining. Sports Med. 1995;20:251–76.CrossRefPubMed

40.

Budgett R, Newsholme E, Lehmann M, et al. Redefining the overtraining syndrome as the unexplained underperformance syndrome. Br J Sports Med. 2000;34:67–8.CrossRefPubMedPubMedCentral

Title: Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)—EROS-HPA Axis
Authors: Flavio A. Cadegiani
Claudio E. Kater
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: Sports Medicine - Open / Issue 1/2017
Print ISSN: 2199-1170
Electronic ISSN: 2198-9761
DOI: https://doi.org/10.1186/s40798-017-0113-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)—EROS-HPA Axis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

The Effect of Fluid Intake Following Dehydration on Subsequent Athletic and Cognitive Performance: a Systematic Review and Meta-analysis

The Maximal Oxygen Uptake Verification Phase: a Light at the End of the Tunnel?

The Effect of Concurrent Plyometric Training Versus Submaximal Aerobic Cycling on Rowing Economy, Peak Power, and Performance in Male High School Rowers

Physical characteristics of players within the Australian Football League participation pathways: a systematic review

Comparisons of Perceived Training Doses in Champion Collegiate-Level Male and Female Cross-country Runners and Coaches over the Course of a Competitive Season

Staphylococcus Aureus Carriage in French Athletes at Risk of CA-MRSA Infection: a Prospective, Cross-sectional Study