Adrenal Gland – the gear box of the car (DHEA and cortisol) underactive
The adrenal gland is responsible for the body’s hormonal response to stress. It produces adrenaline, which stimulates the instant stress hormone response (fight or flight reaction). It also produces cortisol and DHEA, which create the short and long term stress hormone responses. Cortisol suppresses the immune system, breaks down tissues and has a generally catabolic effect. However, these effects are balanced out by DHEA, which has the opposite effect – activating the immune system and building up tissues. All these hormones are made from cholesterol – just one reason why running a low cholesterol is not a good thing!
Both cortisol and DHEA are essential for life – too little cortisol causes the life threatening disease Addison’s disease, too much causes the debilitating condition Cushing’s syndrome. The name of the game is to get the right balance. To achieve this both hormones must be measured. This can be done with the Adrenal stress profile – salivary (ASP) test. By measuring and supplementing within the physiological range, with biologically identical hormones, one is not going to get any unpleasant side effects, i.e. we are trying to copy Nature and restore normality.
The ASP test looks at cortisol and DHEA levels over 24 hours. This test entails taking salivary samples through the day (yippee, no needles!). Indeed, salivary sampling is felt to be the most accurate way of assessing steroid hormone levels.
An abnormal result may be a symptom of other problems or it may cause problems in its own right. The response of the body to stress (any stress – infectious, nutritional, emotional, physical etc) is to increase the output of stress hormones. This gears the body up for action by raising blood pressure, increasing heart rate, improving mental alertness (which can cause anxiety), increasing energy supply and so on. It is actually metabolically very inefficient because it uses up lots of energy, but totally desirable if one has to fight for one’s life! This reaction is essential for short term stress, but unsustainable long term. So time for rest and recovery is equally essential.
Problems arise when the stress is unremitting because eventually the output of the adrenal gland will reduce making one far less able to tolerate stress. Indeed, this is often a complaint of my CFS patients – they simply do not tolerate stress at all well.
The pattern of the result from the adrenal stress test gives some idea where one is along the stress response time line.
Stress responses have been elegantly documented by Hans Selye (Wikipedia:Hans Selye) – indeed he first coined the term “stress”.
Interpretation Of The Adrenal Stress Profile Test for DHEA and Cortisol Levels
Levels of DHEA and cortisol vary according to the level of stress and for how long that stress has been applied. Increasing cortisol production is the normal response to short term stress and is highly desirable, so long as the stress is removed and the adrenal glands can recover. On-going, unremitting stress means the adrenal gland and the whole body is in a constant state of alert, does not get time to recover and eventually packs up. So, there are several stages of adrenal function gradually leading to failure:
1. Normal levels of cortisol and DHEA. Normal result. Normal adrenal gland.
2. Raised cortisol, normal DHEA. This indicates a normal short term response to stress. Typically low blood sugar – See Hypoglycaemia – the full story.
3. Raised cortisol and raised DHEA. The adrenal gland is functioning normally but the patient is chronically stressed. So long as the stress is removed, the adrenal gland will recover completely.
4. High levels of cortisol, low levels of DHEA. The body cannot make enough DHEA to balance cortisol. This is the first sign of adrenal exhaustion. This is the first abnormal response to chronic stress. The patient needs a long break from whatever that chronic stress may be – the commonest chronic stress is Hypoglycaemia – the full story, but also consider insomnia, mental, physical or emotional overload or whatever. Pregnenolone can be supplemented to make the patient feel better, but it must be part of a package of recovery, without which worsening can be expected.
5. Cortisol levels low, DHEA levels low. The gland is so exhausted it can’t make cortisol or DHEA. By this time patients are usually severely fatigued. Often these is loss of diurnal rhythm so no morning peak. This may also be associated with low melatonin at night.
6. Cortisol levels low, DHEA borderline or normal. This probably represents the gland beginning to recover after a long rest. Pregnenolone may be used to help patients feel better whilst they continue their programme of rest and rehabilitation.