Many health experts believe approximately 80% of the population suffers from some level of adrenal insufficiency, yet are only diagnosed when an extreme deficiency (Addison’s disease) or overproduction (Cushing’s disease) of the adrenal hormones are found in routine blood work. This means that many people are trying to manage their lives and daily activities with malfunctioning adrenal glands, which goes undetected, not meeting the level of severity to diagnose disease.

The adrenal glands are a crucial part of the endocrine system although they are no bigger than a walnut. Your adrenal glands — small, peanut-shaped glands located next to your kidneys — are the body’s key producers of stress hormones. Located just above the kidneys, the adrenal glands produce more than 150 different hormones, including adrenaline (sometimes called epinephrine), cortisol, norepinephrine, and dehydroepiandrosterone (DHEA), the major stress hormones in our bodies, absolutely essential to health and vitality. When out of balance, the quality of our health and well-being becomes severely compromised. The adrenals are the body’s first line of defense and the primary component designed to resolve stress.

When adrenal glands are stressed, an autoimmune inflammatory response can occur throughout the entire body. Common cases are caused when the adrenal glands are producing some – but not enough – stress hormones. This is known as adrenal fatigue. (Note: the integrative health world is pioneering in this area, but conventional medicine still does not recognize that adrenal dysfunction includes more than just an absence or excess of adrenal hormones!). Oftentimes, adrenal malfunctions cannot be addressed with just a healthy diet and exercise. And while exercise is a very important part of maintaining a healthy lifestyle, if not done properly for your level of health, exercise can trigger an adrenal crash.

Common causes and triggers of adrenal dysfunction include acute life stressors, surgeries, prolonged emotional stress — particularly when you have an inability to manage this chronic stress, ongoing bacterial or viral infections, accidents or surgeries, insufficient amount of sleep, poor diet and nutritional deficiencies, substance abuse, and more.

The symptoms of adrenal fatigue usually begin gradually. One of the most common symptoms is feeling “tired but wired.” You’re exhausted, but when you are ready to sleep, your mind races, and you feel anxious or stressed, alongside chronic, worsening fatigue, muscle weakness, decreased sex drive, brain fog, and decreased ability to handle stress. In its early stages, diagnosing adrenal insufficiency can be difficult. In conventional medical school, doctors are only taught to look for extreme adrenal malfunction (Addison’s Disease, which occurs when the glands produce far too little cortisol, and Cushing’s Syndrome, which stems from excessive cortisol production) and don’t know how to measure cumulative adrenal fatigue. This is unfortunate because millions of people suffer from adrenal insufficiency and symptoms are often overlooked.

Eventually, if left untreated, adrenal dysfunction and low levels of adrenal cortisol can result in the following: hypoglycemia, muscle aches, low blood sugar, sugar or salt craving, shakiness relieved with eating, moodiness, food sensitivities, allergies, recurrent infections, dizzy when standing, low blood pressure, decrease ability to handle stress, decreased cognitive ability or “brain fog”, swollen ankles that are worse at night, hypoglycemia under stress, a need to lie down or rest after psychological or emotional stress, difficulty getting out of bed, wiped out with exercise and/or inability to tolerate thyroid replacement.

Because the symptoms progress slowly, they are often ignored until a stressful event like an illness or accident causes them to worsen. Sudden, severe worsening of symptoms is called an Addisonian crisis, or acute adrenal insufficiency. Additionally, the stress caused by hormone imbalance, like in perimenopause and menopause for women, is a huge contributor to adrenal fatigue.

In diagnosing adrenal dysfunction, a provider will perform the ACTH stimulation test which measures the levels of cortisol in blood and urine. A normal response after an ACTH injection would be a rise in blood and urine cortisol levels. Abnormal response of this test is indicated by very little or no increase in the cortisol levels.

The ACTH stimulation test is the most commonly used test for diagnosing adrenal insufficiency. In this test, blood cortisol, urine cortisol, or both are measured before and after a synthetic form of adrenocorticotropic hormone (ACTH) is given by injection. ACTH is a hormone produced by the pituitary gland that stimulates the adrenal glands to produce cortisol. The normal response after an ACTH injection is a rise in blood and urine cortisol levels. People with Addison’s disease or long-standing secondary adrenal insufficiency have little or no increase in cortisol levels. When the response to the ACTH test is abnormal, a corticotropin-releasing hormone (CRH) stimulation test can help determine the cause of adrenal insufficiency. In this test, synthetic CRH is injected intravenously and blood cortisol is measured before and 30, 60, 90, and 120 minutes after the injection. People with secondary adrenal insufficiency have absent or delayed ACTH responses. CRH will not stimulate ACTH secretion if the pituitary is damaged, so an absent ACTH response points to the pituitary as the cause. A delayed ACTH response points to the hypothalamus as the cause.

The insulin-induced hypoglycemia test is used to determine how the hypothalamus, pituitary and adrenal glands respond to stress. During this test, blood is drawn to measure the blood glucose and cortisol levels, followed by an injection of fast-acting insulin. Blood glucose and cortisol levels are measured again 30, 45 and 90 minutes after the insulin injection. The normal response is for blood glucose levels to fall (this represents the stress) and cortisol levels to rise.

Proper treatment for adrenal dysfunction can have profound effects. Bioidentical hormone therapy balances your hormones, including the hormones released during stress, with customized prescriptions that fit your body chemistry can greatly improve your quality of life.

Ask a Holtorf Medical Group team member about bioidentical hormone therapy and other successful adrenal dysfunction treatments today.

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