A nonresponse of the hypothalamic-pituitary-adrenocortical system has been described in naturally occurring and in lactate-induced panic attacks.1 As an explanation for this lack of a stress-related endocrine response to panic, some form of response desensitization, as a result of the repeated episodes of panic, has been hypothesized.2 Woods et al,3 having studied cortisol secretion in situational panic attacks, have also suggested that stress-responsive neuroendocrine mechanisms may be activated acutely by panic attacks, but then may undergo adaptation as a result of recurring attacks. They proposed the idea of studying patients experiencing their first attacks in emergency departments to test this hypothesis. In another approach, we characterized the adrenocorticotropic hormone secretion in 2 healthy volunteers who experienced their first-ever panic attack during lactate infusion, which can happen in up to 40% of control subjects.4
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Adrenocorticotropic hormone (ACTH) responses to sodium lactate and normal saline infusions in healthy volunteers (top, subject 1; bottom, subject 2).
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