Adrenal Insufficiency

The human body is well equipped to handle stress. Several hormones and neurotransmitters are at the center of the body’s stress response system and are secreted from the adrenal glands, which are located at the top of the kidneys. The adrenal cortex forms the outer layer of the adrenal glands, comprising about 90% of the adrenal mass. The remaining core is called the adrenal medulla. The adrenal cortex secretes different steroid hormones (aldosterone, cortisol, and androgens); the adrenal medulla secretes the catecholamines epinephrine and norepinephrine.1

The body responds to physical, emotional, psychological, and biochemical stresses by releasing cortisol. To do so, stress is initially sensed in a part of the brain called the hypothalamus, which then releases corticotropin releasing hormone (CRH). CRH stimulates the anterior pituitary gland (also located in the brain) to produce adrenocorticotropic hormone (ACTH), which triggers receptors in the adrenal cortex to release the appropriate amount of cortisol. When the sympathetic (“fight or flight”) nervous system is activated, the adrenal cortex responds by releasing cortisol while the medulla releases epinephrine and norepinephrine. Cortisol as well as epinephrine/norepinephrine increase heart rate and blood pressure diverting blood to the brain, heart, and skeletal muscle.2

Adrenal insufficiency is a well-documented condition in which the adrenal glands cannot keep up with the stress response of the body. This can happen if there is destruction of the adrenal cortex (called primary adrenal insufficiency) or if factors outside of the adrenal glands stimulate them to produce less cortisol (called secondary adrenal insufficiency).3

Many medical practitioners additionally believe in a subclinical condition called adrenal fatigue or burnout. Here, the adrenals have been working hard to keep up with high physical, psychological, or emotional stress demands over a prolonged period of time.4 It is hypothesized that sustained levels of high cortisol may lead to decreased responsiveness in the pituitary and adrenal glands.

Symptoms of adrenal insufficiency and adrenal fatigue overlap considerably and include: fatigue, body aches, difficulty concentrating, malaise, depression, decreased libido, low blood pressure, lightheadedness, loss of body hair, hyperpigmentation, etc. 5

Among practitioners, there is controversy regarding the best measurement of cortisol. Many people feeling strongly that salivary, not serum, levels more accurately reflect adrenal function.6 Salivary cortisol testing is easy to collect, although testing may not be widely available and testing criteria have not been uniformly accepted.7 Salivary cortisol is checked from 7 a.m.–9 a.m., 11 a.m.–1 p.m., 3 p.m.–5 p.m., and 10 p.m.–12 a.m.

At RMRM, we perform a comprehensive review of your symptoms and past medical history, then determine the most appropriate diagnostic testing for you, followed by a treatment plan specific to your deficiencies.

  1. S. Nussey, S. Whitehead: The adrenal gland. Accessed February 14, 2015
  2. Meletis C.D.: Clinical natural medicine handbook, New Rochelle, New York, 2008, Mary Ann Liebert Inc., pp. 1-20.
  3. UpToDate: Clinical manifestations of adrenal insufficiency in adults .∼150&sectionRank=2&anchor=H19#H19 Accessed February 20, 2015
  4. Natural Standard: Addison’s disease . Accessed April 14, 2014
  5. J.L. Wilson: Clinical perspective on stress, cortisol and adrenal fatigue. Adv Integr Med. 1 (2):93-96 2014  
  6. S. Tunn, H. Möllmann, J. Barth, H. Derendorf, M. Krieg: Simultaneous measurement of cortisol in serum and saliva after different forms of cortisol administration. Clin Chem. 38 (8 Pt 1):1491-1494 1992  
  7. R.F. Vining, R.A. McGinley, J.J. Maksvytis, K.Y. Ho: Salivary Cortisol: a Better Measure of Adrenal Cortical Function than Serum Cortisol. Ann Clin Biochem An Int J Biochem Lab Med. 20 (6):329-335 1983