Adrenal Dysfunction – How Do You Identify It?

Adrenal Dysfunction - Lets first look at what our Adrenals are and what they do… Adrenal glands are tiny but they play a massive role in the body. These tiny obscure little triangular organs measuring usually 1.5 inches in height and 3 inches in length; sit upon each one of our kidneys… hence the name “Ad” Latin for “near” and “Renal or renes” Latin for 'kidneys'. (1)

They contribute to a system within the body called the “endocrine system” many will associate this with the system of hormonal function, distribution, and balance. Our adrenal glands form part of this system along with our Parathyroid glands, pituitary gland, thyroid gland, pancreas, ovaries, and testes – this entire system works so intricately in the body to produce and regulate hormones that control just about every single thing that we do.

Specifically – our adrenal glands affect our Metabolism, our blood pressure, immune system, our sex hormones and the major factor we will be discussing and breaking down in more detail today… how we respond to stress!(2)

What do our adrenals have to do with how we respond to stress, isn’t that all in the mind!?

Incorrect, but there is an element of truth… both are intimately connected. The Adrenal gland forms part of what is called the HPA Axis – this is the Hypothalamic Pituitary Adrenal Axis. In essence, a communicative axis that dictates a response to information taken in. A governing body if you will, it signals for an order and the flow-on effect of that is action elsewhere in the body, here it's in the adrenal gland.

When we look at the hypothalamus in the brain, this acts much like an internal thermometer or if you are a machinery nerd, a thermostat. What do thermostats do? Open or close like a valve in response to temperature change to regulate temperature to the desired setting. Often seen in cars but in this instance, it's our brain. This desire to maintain balance and core settings is called “Homeostasis” we are very rarely dead-center perfect, but it’s a goal the body is constantly trying to maintain. The hypothalamus detects a change and shoots off signaling to the pituitary gland. To which the pituitary gland takes this signal and distributes the orders to various organs and glands to initiate action and change. Quite intricate and amazing really, all without a single conscious thought!

Hormones of the Adrenal Gland

Taking this direction from the pituitary gland, the adrenals have the capacity to produce an array of hormones including Aldosterone, androgens/sex hormones cortisol, and Adrenaline.

Today we are looking at Cortisol – Cortisol is often associated with stress; this can be physiological stress and mental stress. Anything that triggers a stress response of fight or flight, be it a bill or a vicious tiger… its all stress and triggers the same response.

The role of Cortisol in the Body

Adrenal glands secrete cortisol in response to feedback given on a 'stress trigger', it’s the mediator it comes in to settle and return the body back to a calm state or as near possible to balance/homeostasis. Cortisol supplies the following functions:

• Increase available glucose to the nervous system to supply quickly available energy for fight or flight, and can extract this by breaking down protein and fat to useable energy and will prioritize this to the central nervous system while avoiding uptake into other tissues. An important survival technique.

• Anti-inflammatory actions, cortisol regulates inflammation in response to physical injury as well as immune function and response.

Stress, punch, and run/fight or flight – heart rate goes up, blood pressure goes up energy supplies are increased and prioritized, we switch into razor-sharp tunnel vision focus to escape and slow down other axis function as a later priority, which when you think about it... The desire for sex from the sex axis is not really required when you’re trying to run for your life right?! Unless you like to live life dangerously, I guess, but your body won’t give you much say on that one sorry! Cortisol and Adrenaline team up to make this happen so we survive.(5)

Are we “Punching and Running” from Modern-Day Issues?

The truth is, we aren't cave dwellers anymore, we don’t have to lug a club and fend off lions and tigers and snakes in our boots. We live what we would very well consider a “comfortable life” when it comes to innate desire to flee and be consistently vigilant for prey that may like to make us a snack.

However, our human genome has not advanced enough to be able to tell the difference between modern stress and ancestral stress. Now, we are more likely to have phone calls, a grumpy boss, bumper to bumper traffic where you look away for a second and nearly run up the ass-end of the car in front of you – the type of stressors.(6)

When we talk about “Adrenal Dysfunction” we are not looking at a one size fits all approach. Let’s have a look at the various stages of adrenal dysfunction below.

Stages of Adrenal Function/Dysfunction

Baseline – Normal/Balanced

We will reflect on this section here as to what a good baseline of adrenal function should runoff. Cortisol secretion in the morning blocks sleep chemicals to wake you up so you couldn’t possibly roll over and go back to sleep now that you are awake; while inhibiting inflammation relieving aches and pains, sinus, hay fever, and rashes. As evening comes, cortisol drops dramatically, and sleep chemicals rise so you are forced into a nice deep sleep. While sleeping cortisol drops extremely low and the immune system and other regenerative and anabolic systems fire up to grow, repair, and generally clean up.

Acute Stress

Acute Stress falls inline with Normal Baseline Cortisol, it spikes when needed throughout the day to help overcome stressors before returning to normal.

Chronic Stress

Exaggerated and prolonged cortisol spike. Start waking up with high cortisol and it spikes from there and never really drops enough all day and night for chronic elevated cortisol exposure. Nervous energy all day and restless, unrefreshing, light sleep.

Hyper-Reactive

Born pre-wired, acquired acute (PTSD), or chronic stress. Fibromyalgia, Insomnia, depression borne from anxiety. Due to cortisol resistance, you have learned to release extra cortisol in response to stress and subsequently an exaggerated stress response. Referred to as melancholic depression in literature and responds to serotonin preserving antidepressants

Constant excessive exposure leads to cortisol resistance and low levels now fail to register so the body pumps out more and more. This causes a vicious cycle that results in a phase of conservation or adrenal fatigue.

Conservation Mode

Fibromyalgia / Chronic fatigue syndrome, shift workers, mums, acquired by progressing through the stages of HPA maladaptation. Auto-immune, excessive inflammation, allergies, fatigue, and pain.

Not enough to get up and going but too much to get a good night’s sleep. Light sleep and seem more awake before bed then when you rose. Wake unrefreshed. Need stimulants to get going and only temporary. Usually sensitive to glare, thirsty all the time but can’t hold water so need to urinate constantly, crave salt and/or sugars

• Wake with pain that gradually leaves.

• Chronic inflammation leads to all age-related disorders.

The conservation phase can also manifest as bizarre cortisol patterns that reflect poor sleeping patterns and adaptations to lifestyle in shift workers, mums, and hospitality and security workers.

Hypo Reactive (Adrenal Fatigue)

Born congenital defect, autoimmune, exhaustion, Chronic Fatigue Syndrome. Hypersomnia, pain, inflammation, depression is borne from apathy and fatigue with low cortisol and excessive serotonin activity. Referred to as atypical depression in literature and doesn’t respond to serotonin preserving antidepressants well.

What can you do to find out more for yourself? 

A great place to start is your environment, limit stressors that are avoidable, pay attention to how you feel during the day, and how wired you may be at night time. If you feel like something is off, check in with your Naturopath or Health Care Practitioner on a saliva cortisol test to give you a more accurate reading.

From here you can work on sleep patterns, diet, and supplementation to address your concerns as a full holistic picture.

References: 

1. https://www.dictionary.com/browse/adrenal

2. Discovering the Role of the Adrenal Gland in the Control of Body Function. David C Randall. 2004 Nov;287(5):R1007-8. doi: 10.1152/classicessays.00017.2004.

3. Role of the Hypothalamic–Pituitary–Adrenal Axis in Health and Disease. Sharon DeMorrow. Int J Mol Sci. 2018 Apr; 19(4): 986. Published online 2018 Mar 26. doi: 3390/ijms19040986

4. How should we interrogate the hypothalamic-pituitary-adrenal axis in patients with suspected hypopituitarism? Aoife Garrahy& Amar Agha BMC Endocrine Disorders volume 16, Article number: 36 (2016)

5. https://www.nrdc.org/experts/kristi-pullen/getting-know-hpa-axis

6. The Human Stress Response. Nat Rev Endocrinol 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Georgina Russell1, Stafford Lightman 2