Figure 1.

Involvement of the hypothalamic–pituitary–adrenal axis in alcohol-induced immune suppression. Alcohol exposure stimulates the hypothalamus to produce corticotropin-releasing hormone (CRH). This triggers the pituitary gland to secrete adrenal corticotropic hormone (ACTH), which in turn stimulates the adrenal glands to release glucocorticoids. At high levels, glucocorticoids signal white blood cells to alter cytokine production, suppressing inflammatory and immune responses. (Yellow arrows indicate increased or decreased production or activity.)