Is Adrenal Fatigue real?

NOVEMBER 24, 2015 by DR. HEATHER MODAY, MD

Well, in terms of semantics- no. This may come as a shock to many of my clients as one of my go-to standard tests is  a 4 point cortisol and DHEA saliva test. So let me explain, adrenal fatigue is not a medical term, but it’s something that we can all understand conceptually and it’s much easier than saying that you have dysregulation of your Hypothalamic- Adrenal-Pituitary Axis (HPA), which in reality is what is actually happening. The symptoms of this HPA axis dysfunction can mimic many other issues going on on the body, as the symptoms range from weight gain, fatigue, sugar cravings, anxiety, poor sleep, frequent infections, lightheadedness, muscle aches and loss of libido. Sound familiar?? Obviously these symptoms can occur with many other issues and I bet most of us of us can relate to a few of them at some time in our lives. The reason I always do adrenal testing is that I know that it is hard to correct many other hormonal imbalances such as sex hormones and thyroid issues without checking out the good old HPA axis first.

A little background: My real introduction to the HPA came while I was toiling as a lab tech in the 1990’s in the Neuroendocrine laboratory of Dr. Bruce McEwen where stress and its effect on the brain and the immune system was the main  subject of research. My job was working on the neuroimmunology team which basically had me stressing lab rats in various manners and then looking at how this harmed their immune system. Little did I know then that many years later, I would be addressing the health of the HPA axis in all of my clients. So the term “stress ” is really a state or a response to a threat to our safety or balance, and it’s something that we deal with everyday. How this affects our adrenal glands and hormones is through the HPA axis.

Without being overly technical and boring – this is basically how it works. We  perceive a stressor (hate your job, commute, etc) which activates the hypothalamus in our brain, to release corticotropin releasing factor (CRF). This then acts on the pituitary gland which releases ACTH (Adrenocorticotropic hormone) which then activates  the adrenal glands. Now the adrenal glands secrete several hormones including epinephrine and norepinephrine along with cortisol.

So the beauty of this axis is that we have negative feedback mechanisms built in. So theoretically the presence of cortisol will shut off continued release of CRF and ACTH once the stress is gone. However because we are chronically stressed  in our modern lives, this doesn’t happen. So we keep pouring cortisol out to keep up with the demands of stress. Initially there may be high levels of cortisol, but after a while, the whole system stops communicating so well and the levels of cortisol maybe drop at certain times of the day and surge at others and finally may just remain really low.

Also, the building blocks that make up cortisol as well as the other adrenal homone DHEA and many sex hormones come from a pre-hormone called pregnenalone. Constant need to make more and more  cortisol literally will “steal” pregnenalone from the supply chain of  other sex hormones like DHEA and testosterone, resulting in symptoms of low libido, mood issues and weight gain amongst others. Now cortisol- when it’s normally secreted, has a nice circadian rhythm and is crucial for the regulation of blood sugar, heart rate and blood pressure, immune health, and many other important systems in the body. When it becomes dysregulated, all those symptoms of  “adrenal fatigue” may occur.

So in the end, it’s not that the adrenal glands are permanently damaged in any way, it’s that the entire system has sort of fallen apart. Despite the slightly inaccurate/non-medical terminology of “adrenal fatigue”, it paints a picture that we can all relate to. That is why it is so important to get the  correct tests done looking at several measurement points throughout the day to make sure that the adrenal glands are secreting the right amounts of hormone  at the right time. There are many strategies that I have written about before that can be undertaken on your own for mending HPA axis dysregulation like proper sleep, meditation, stress reduction, blood sugar management and adaptogenic herbs. However, treating with pregenalone and DHEA should only be done under a practitioners care and recovery may take many months until proper function returns.