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Functional Adrenal Stress: What does science say?

Depression, Mental Health, Stress | October 10, 2014 | Author: The Super Pharmacist

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Functional Adrenal Stress: What does science say?

Functional adrenal stress is a pseudoscientific term that describes a state of putatively abnormal function of the adrenal glands. Functional adrenal stress is not a condition that would be recognised by your physician nor does it appear in the peer-reviewed literature.Therefore, any discussion of functional adrenal stress is restricted to what has been published by diagnostic testing companies and alternative medicine practitioners.

The adrenal glands

The adrenal glands are small, pyramidal shaped organs that are located on top of the kidneys; one adrenal gland rests on top of each kidney.

The adrenal glandsEach adrenal gland is comprised of several anatomical layers, each layer secreting its own type of hormones.

The adrenal cortex layer, for instance, produces and secretes corticosteroids and sex hormones.

The adrenal medulla secretes catecholamines such as adrenaline and noradrenaline.

Cortisol, a corticosteroid, is the body’s stress hormone. Cortisol is released into the bloodstream by the adrenal glands in response to stressful situations, whether those stresses are physical, psychological, emotional, or all of the above.

Short-term elevations in cortisol can be helpful and even critically important for the proper functioning of the body; however, long-term elevations in cortisol can cause anxiety, memory disturbances, cardiovascular problems, mood disorders, and disturbances in the endocrine system.

Functional Adrenal Stress – A Definition

There is no single, uniformly accepted definition of functional adrenal stress. It is perhaps best described as a condition of long-term, chronic stress that increases to a point at which the adrenal glands stop functioning properly or optimally.

The symptoms of functional adrenal stress are the same as those of chronic stress: fatigue, depression, weight gain, sexual dysfunction, insomnia, impaired memory, irritability, and myalgia.

Since their symptoms are the same, it is difficult to determine exactly when chronic stress becomes “functional adrenal stress.”

Alternative practitioners recommend blood tests to measure the levels of various hormones created and secreted by the adrenal glands in order to test for functional adrenal stress.

Burnout

In defining functional adrenal stress, some authors describe a “burnout” process that occurs in the adrenal glands and is separated into three stages.

BurnoutThese three stages include: stress overload, fatigue and exhaustion. 
Stress overload describes a state in which the body experiences stress and the adrenal glands respond by excreting excessive amounts of stress hormones.
The fatigue stage, the adrenal glands begin to “fail” and do not respond with a robust stress response.
Exhaustion describes a state in which the adrenal glands no longer produce cortisol or other stress related hormones.

Functional adrenal stress testing

Proponents of the condition “functional adrenal stress” advocate measuring the hormones secreted by the adrenal glands. These laboratory tests include measurements of cortisol, DHEA, various oestrogens, progesterone, testosterone, and melatonin in saliva or blood. Since cortisol levels can vary depending on the time of day, measurements may need to be taken up to four times during waking hours and compared against normal ranges. Manufacturers and marketers of these laboratory tests, which they call the “functional adrenal stress panel,” state that elevations in cortisol may suggest an increased stress response while decreases in cortisol may suggest adrenal fatigue. They also state that an elevated cortisol to DHEA ratio indicates a chronic stress response.

Accepted medical conditions related to adrenal function

While functional adrenal stress itself is not a true medical condition, as defined by traditional medical practitioners (i.e. allopathic physicians) a number of medical conditions are caused by abnormalities in the adrenal glands. For example, Cushing's syndrome is a condition in which the adrenal glands produce too much cortisol. People with Cushing's syndrome have abnormally high levels of cortisol in the blood and experience weight gain, especially around the torso and face, easy bruising, “stretch marks” from rapid weight gain, insomnia, sexual dysfunction, and cognitive disturbances.

On the other hand, patients may have adrenal insufficiency, in which the adrenal glands do not produce enough cortisol and aldosterone. Adrenal insufficiency may cause weight loss, dehydration, altered mental status, and low blood sugar. People with adrenal insufficiency may feel tired and dizzy and experience muscle aches, nausea, vomiting, and diarrhoea.

Is functional adrenal stress the same as adrenal insufficiency?

Adrenal insufficiency and functional adrenal stress appear to be similar clinical entities. In both cases, the adrenal glands do not secrete sufficient amounts of hormones. However, proponents of functional adrenal stress describe it as a stress-induced mechanism which causes adrenal insufficiency. In other words, in someone who experiences chronic stress over a long period of time, the adrenal glands may eventually fail to secrete hormones.

Adrenal insufficiency can be triggered by several mechanisms: trauma, infection, cancer, side effects of drugs, inflammatory disease, and autoimmune conditions; however, there is no documented evidence in the scientific community that can demonstrate adrenal insufficiency is caused by chronic stress.

Treatment for functional adrenal stress

Once functional adrenal stress is diagnosed, the treatment consists of stress-relieving activities.

Treatment for functional adrenal stressBetter sleep hygiene, a healthful diet, stress-reducing activities such as cardiovascular exercise, meditation, resistance training, and yoga, and removing toxins from one’s environment—any or all of these can alleviate functional adrenal stress.

These activities are recommended for anyone suffering from long-term stress, regardless of whether they are tested for functional adrenal stress or not.

If functional adrenal stress is an actual medical condition, then adrenal exhaustion should be approached in appropriately according to severity and may warrant direct treatment. For example, acute adrenal insufficiency is a medical emergency, while chronic adrenal insufficiency is treated with short and long-acting glucocorticoids, mineralocorticoid replacement, and androgen replacement. Patients diagnosed with functional adrenal stress should explore all possible treatment options.

Summary

“Functional adrenal stress” is a term used by alternative medicine practitioners and is not directly related to any accepted medical condition. There is no evidence to suggest that chronic stress can cause the adrenal glands to suffer “fatigue” and stop producing hormones.

Various events and disease processes can affect the adrenal glands, causing abnormally high or abnormally low levels of adrenal hormone secretion. These separate medical conditions require specific treatments.

Tests for functional adrenal stress are unlikely to provide any additional information to physicians about the status of the adrenal glands, but individual tests such as those measuring cortisol levels may be useful as part of a work-up for an adrenal gland disorder diagnosis.

A healthy diet, routine exercise, and effective stress management should be important parts of everyone's lives. If the test results for functional adrenal stress promote those health related lifestyle factors, it is difficult to condemn the process, provided immediate care requirements are met and patients are not delayed from potentially important treatment.

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References

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Jyotsna VP, Naseer A, Sreenivas V, Gupta N, Deepak KK. Effect of Cushing's syndrome - Endogenous hypercortisolemia on cardiovascular autonomic functions. Auton Neurosci. Feb 24 2011;160(1-2):99-102.

Gillespie CF, Nemeroff CB. Hypercortisolemia and depression. Psychosom Med. May-Jun 2005;67 Suppl 1:S26-28.

Prague JK, May S, Whitelaw BC. Cushing's syndrome. BMJ. 2013;346:f945.

Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. Aug 1 2014.

Bouillon R. Acute adrenal insufficiency. Endocrinol Metab Clin North Am. Dec 2006;35(4):767-775, ix.

Grossman AB. Clinical Review#: The diagnosis and management of central hypoadrenalism. J Clin Endocrinol Metab. Nov 2010;95(11):4855-4863.

 

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