“…Nevertheless, significantly elevated or altered levels of adrenocorticotropic hormone (ACTH), cortisol, testosterone, and luteinizing hormone have been observed post-call and are associated with increased levels of stress, anxiety, and depressive symptoms [41,42]. While on-call, surgical residents achieve stress levels of tachycardia and exhibit a significant increase in their level of circulating white blood cells [43]. Recently, Brant et al [44] found that while residents did not report a change in stress levels over the course of a rotation, they exhibited evidence of neuro-endocrine changes consistent with hypothalamic-pituitary-adrenal (HPA) axis dysregulation.…”