February 27, 2013

Adrenal Fatigue

Adrenal Function Panel

The Adrenal Function Panel is one method for measuring ability to cope with stress. Basically, a stressor induces neuroendocrine cells to release corticotropin releasing factor (CRF), which stimulates release of adrenocorticotropic hormone (ACTH) and triggers cortisol release. Prolonged exposure to stressors may result in General Adaptation Syndrome, which consists of three major stages of adaptation to stress.

General Adaptation Syndrome
  • Alarm StageIn response to a stressor, the adrenal glands release adrenaline and noradrenaline along with cortisol and DHEA. Increased levels of these hormones enable the body to mount a response to the stressor. This results in the traditional —fight, flight or freeze“ response.
  • Resistance StageDuring this stage, higher than normal levels of cortisol stimulate the conversion of proteins, fats and carbohydrates into energy, helping the body adapt to stress. However, a lengthy Resistance Stage is maladaptive, as sustained cortisol elevation increases the risk of developing stress related diseases. Symptoms of elevated cortisol may include: feeling tired but wired, difficulty sleeping, and anxiety. Excess cortisol can interfere with the action of progesterone
    and testosterone at receptor sites and could lead to symptoms of hormone imbalance.
  • Exhaustion StageAt this stage, the adrenal glands are no longer able to mount a suitable response to stress. Depletion of the adrenal glands reduces production of cortisol, DHEA and aldosterone. DHEA levels likely decrease first, but deficiency symptoms are not well defined. Lack of aldosterone may result in hypokalemia, hyponatremia and dehydration. Symptoms of low cortisol may include fatigue (particularly morning fatigue), increased susceptibility to infection, decreased
    recovery from exercise, allergies, hypoglycemia, burned out feeling, depression and decreased sex drive.
Why Test Saliva Cortisol?
  • Clinicians can often make a diagnosis of adrenal exhaustion solely on the basis of history and physical examination, but saliva hormone testing can be useful in the following instances:
  • The diurnal variation of cortisol is readily mapped by using saliva testing since collection is easy to do at home or at work. Four specimens are obtained: morning (within first hour of waking), before lunch, before supper, and before bedtime. The cortisol levels for each point are graphed according to the reference range for that time period.
  • Saliva is an excellent medium for measurement of cortisol because, unlike blood and serum where venipuncture can cause an anticipatory rise in cortisol, collection of saliva does not..
Background on Cortisol

The adrenal glands produce cortisol 24 hours per day with a regular diurnal variation. Cortisol output is highest within the first hour after waking, declines steadily through the day, and reaches a low during sleep. Adrenal exhaustion tends to result in a flattened cortisol profile with loss of the morning surge, while earlier stages of the General Adaptation Syndrome generally result in one or more elevated cortisol points.

Background on DHEAS

DHEA, or dehydroepiandrosterone, is also secreted by the adrenal glands. It is the most abundant steroid hormone in the body, circulating primarily in its sulphated form, DHEA-S. DHEA competes with cortisol at the receptor level, and balances the effects of cortisol. The ratio of cortisol to DHEA tends to increase with age because DHEA-S declines with age, while morning cortisol stays the same or increases slightly. A higher than expected ratio for a given age may be indicative of unbalanced adrenal function (cortisol too high or DHEA-S too low). Factors contributing to imbalance may include acute or chronic stress, obesity, metabolic syndrome or diabetes, and hypothyroidism.