hypothalamic - pituitary - adrenal ( hpa ) axis dysfunction in mood disorders is one of the most robust findings in biological psychiatry . however , considerable debate surrounds the nature of the core abnormality , its cause , consequences and treatment implications . to review the evidence for the role of hpa axis dysfunction in the pathophysiology of mood disorders with particular reference to corticosteroid receptor pathology . a selective review of the published literature in this field , focusing on human studies . the nature of basal hpa axis dysregulation described in both manic and depressed bipolars appears to be similar to those described in mdd . but studies using the dexamethasone/ corticotropin releasing hormone ( dex / crh ) test and dexamethasone suppression test ( dst ) have shown that hpa axis dysfunction is more prevalent in bipolar than in unipolar disorder . there is robust evidence for corticotropin releasing hormone ( crh ) hyperdrive and glucocorticoid receptor ( gr ) dysfunction in mood disorders , with increasing evidence for disorders within the avp system . hpa axis dysfunction is prevalent in patients with mood disorder , particularly those with psychotic disorders and bipolar affective disorder . dysfunction of gr may be the underlying abnormality and preliminary findings suggest that it is a potential target for novel therapies .
background :   hypothalamic - pituitary - adrenal ( hpa ) axis dysfunction in mood disorders is one of the most robust findings in biological psychiatry . 
 however , considerable debate surrounds the nature of the core abnormality , its cause , consequences and treatment implications.aims : to review the evidence for the role of hpa axis dysfunction in the pathophysiology of mood disorders with particular reference to corticosteroid receptor pathology.methods : a selective review of the published literature in this field , focusing on human studies.results : the nature of basal hpa axis dysregulation described in both manic and depressed bipolars appears to be similar to those described in mdd . but 
 studies using the dexamethasone/ corticotropin releasing hormone ( dex / crh ) test and dexamethasone suppression test ( dst ) have shown that hpa axis dysfunction is more prevalent in bipolar than in unipolar disorder . 
 there is robust evidence for corticotropin releasing hormone ( crh ) hyperdrive and glucocorticoid receptor ( gr ) dysfunction in mood disorders , with increasing evidence for disorders within the avp system.conclusion : hpa axis dysfunction is prevalent in patients with mood disorder , particularly those with psychotic disorders and bipolar affective disorder . 
 this may be secondary to genetic factors , early life adversities or both . 
 dysfunction of gr may be the underlying abnormality and preliminary findings suggest that it is a potential target for novel therapies.declaration of interest : none