HPA axis dysfunction/Adrenal Fatigue

HPA axis dysfunction/Adrenal Fatigue

Mar 12, 2018

The hypothalamic–pituitary–adrenal (HPA) axis is part of the endocrine system, the chemical messenger system of the body through which hormones are secreted. It consists of the hypothalamus, the pituitary gland, and the adrenal glands. When you face a stressor (big or small), it is this system that creates the stress response in the body, releasing a hormone known as corticotropin releasing hormone, or CRH, which triggers the release of another hormone, adrenocorticotropic hormone (ACTH), from the pituitary gland. Once it has been released, ACTH travels through the bloodstream down to the adrenal glands, where it triggers the release of the steroid hormone cortisol. Cortisol prepares the body for the “fight or flight” state to face potential threats by suppressing certain systems and giving it a burst of energy with a surge of glucose.

The HPA axis works as a feedback loop, meaning that the output of one of the glands loops back around to become input elsewhere. When the hypothalamus and pituitary gland receive signals that high levels of cortisol have been released, they stop production of CRH and ACTH, which in turn stops production of cortisol from the adrenals. The stress response ends with the decrease of cortisol, and the body can calm down and hormone levels return to normal. When the body experiences chronic stress, dysfunction can occur in this system. Hormones continue to be released on an accelerated basis. Over time, this can cause the glands of the HPA axis to become desensitized and stop recognizing signals to stop producing hormones. When this dysfunction is not corrected, it becomes the norm and can lead to adrenal fatigue.

Adrenal fatigue

This condition is the collection of symptoms that occur when the adrenal gland is underproductive. It has become popular in the natural and alternative health world in recent years and is surprisingly common in the United States. It is most often associated with periods of intense or prolonged stress, but can also develop during or after acute or chronic infections.

While many alternative practitioners focus on the adrenal glands as being the main source of dysfunction, it is only part of the problem. It is actually the entire HPA axis that is malfunctioning and therefore, treating only one part would be insufficient and ineffective. The feedback loop of the HPA axis must be addressed and corrected to relieve symptoms associated with adrenal fatigue.


There are many symptoms that accompany HPA axis dysfunction, such as:

  • Sleep problems/difficulty getting up in the morning
  • Insomnia
  • Thyroid dysfunction
  • Blood pressure problems/poor circulation
  • Lowered immune system
  • Blood sugar problems
  • Increase in abdominal fat
  • Brain fog/fatigue (especially during the morning and mid-afternoon)
  • Inability to handle stress
  • Inflammation
  • Slow wound healing
  • Cravings for salt or salty foods
  • Dizziness
  • Dry skin
  • Low libido
  • Poor muscle tone
  • Depression/anxiety

The biggest sign of adrenal fatigue is tiredness that is not relieved with quality sleep. In this way, it is not an illness that has obvious, physical signs (those who have the condition may not look ill at all), but is one that needs treatment to preserve good health and wellbeing.

Effects of the adrenal hormones

Cortisol and DHEA, two adrenal hormones, have genetic influences on the body, penetrating cells to enter the nucleus, where DNA is unlocked and transcribed. Cortisol is valuable in assessing overall health as it is the main hormone that directs immune function. These two hormones are also involved in carbohydrate, protein, and fat metabolism; immune system modulation; detoxification capacity; hormone balance; and muscle, bone, and neural tissue health.

Effects of adrenal fatigue

A healthy balance of cortisol levels in the body is highly important to overall health. The production of too much cortisol can “burn up” the body while insufficient levels of it can cause the body’s internal machinery to malfunction, especially at the cellular level. The combination of elevated levels of cortisol and low levels of DHEA results in what is referred to as a Chronic Stress Response. In this state, the body is losing, or has lost, the ability to modulate bodily functions and is on the way to further hormone, immune, and metabolic breakdown. This has several effects on the body, such as:

  • Disrupted sleep patterns
  • Negative effect on brain function, memory, learning
  • Change in mood
  • Excess fat around the hips, thighs, or waist
  • Compromising of the body’s mucosal linings, its first line of immune defense
  • Overall weakening of the immune system, increasing risk of infections and allergic reactions
  • Increased risk for cancer, cardiovascular disease, autoimmune disease, and a variety of degenerative diseases
  • Accelerated aging

Stages of adrenal fatigue

Stage 1: cortisol increases and DHEA and its metabolites decrease or an imbalance occurs between testosterone and estrogen

Stage 2: continuing high levels of ACTH leading to a further decrease in DHEA and eventually a decrease in the output of cortisol

Stage 3: an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. High levels of ACTH continue to be present while levels of DHEA continue to decrease. The adrenal glands have now become exhausted and are losing their capacity to produce sufficient amounts of cortisol. This can eventually lead to a crash of the HPA axis, preventing the system from maintaining homeostasis.

Testing and treatment

We have a great deal of experience in treating individuals affected by adrenal fatigue. Dr. Kirmani tests patterns of adrenal activity using saliva and urine testing and by monitoring neurotransmitters. Function is restored to the adrenal gland using a customized prescription of nutrient formulas, herbal support, and specialized amino acid formulas which can return the nervous system to top condition. It is also important to address the issue of stress, so that the condition does not return. Dr. Kirmani provides counsel to patients to help them make healthy lifestyle choices regarding diet, exercise, and sleep to lead their healthiest lives.

March 12, 2018

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