Although the initial rise in cortisol follows a large surge in adrenocorticotropic hormone levels, if long-term inflammatory stress occurs, adrenocorticotropic hormone levels return to near basal levels while cortisol levels remain raised as a result of increased adrenal sensitivity. During acute stress, cortisol levels rise and pulsatility is maintained. The end product of this pathway - cortisol - is secreted in a pulsatile pattern, with changes in pulse amplitude creating a circadian pattern. The hypothalamic–pituitary–adrenal axis is a key regulatory pathway in the maintenance of these homeostatic processes. This objective is achieved through autoregulatory neural and hormonal systems in close association with central and peripheral clocks. The human stress response has evolved to maintain homeostasis under conditions of real or perceived stress.
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