The Cortisol Diurnal Pattern describes the predictable, time-dependent fluctuation of circulating cortisol concentrations throughout a 24-hour cycle in a healthy individual. Clinically, this pattern is characterized by a peak, often termed the Cortisol Awakening Response (CAR), occurring shortly after waking, followed by a steady decline toward nadir levels late in the sleep period. Deviation from this established rhythm, such as flattened curves or elevated nighttime levels, strongly indicates HPA axis dysregulation. Assessing this pattern provides a superior diagnostic measure compared to single-point cortisol testing.
Origin
This pattern is fundamentally derived from the study of the hypothalamic-pituitary-adrenal (HPA) axis, the body’s primary stress response system. The concept of a diurnal cycle is intrinsic to the body’s endogenous timing system, governed by the suprachiasmatic nucleus (SCN). The term emphasizes the cyclical nature of adrenal steroid release, which evolved to coordinate alertness and metabolic readiness with the light-dark cycle.
Mechanism
The mechanism driving this pattern involves rhythmic activation of the HPA axis, initiated by the release of CRH from the hypothalamus synchronized to the circadian pacemaker. Corticotropin-releasing hormone stimulates ACTH release from the pituitary, which in turn signals the adrenal cortex to synthesize and secrete cortisol. This feedback loop ensures that peak cortisol availability aligns with morning alertness requirements, facilitating glucose mobilization and metabolic activation for the day’s activities. Maintenance of this precise timing is essential for metabolic stability and immune modulation.
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