Adrenal Function Panel
The Adrenal Function Panel is one method for measuring ability to cope
with stress. Basically, a stressor induces neuroendocrine cells to
release corticotropin releasing factor (CRF), which stimulates release
of adrenocorticotropic hormone (ACTH) and triggers cortisol release.
Prolonged exposure to stressors may result in General Adaptation Syndrome, which consists of three major
stages of adaptation to stress.
General Adaptation Syndrome
- Alarm Stage
In response to a stressor,
the adrenal glands release adrenaline and noradrenaline along with
cortisol and DHEA. Increased levels of these hormones enable the body
to mount a response to the stressor. This results in the traditional
—fight, flight or freeze“ response. - Resistance Stage
During this stage, higher than normal levels of cortisol stimulate the
conversion of proteins, fats and carbohydrates into energy, helping the
body adapt to stress. However, a lengthy Resistance Stage is
maladaptive, as sustained cortisol elevation increases the risk of
developing stress related diseases. Symptoms of elevated cortisol may
include: feeling tired but wired, difficulty sleeping, and anxiety.
Excess cortisol can interfere with the action of progesterone
and testosterone at receptor sites and could lead to symptoms of hormone imbalance. - Exhaustion Stage
At this stage, the adrenal glands are no longer able to mount a
suitable response to stress. Depletion of the adrenal glands reduces
production of cortisol, DHEA and aldosterone. DHEA levels likely
decrease first, but deficiency symptoms are not well defined. Lack of
aldosterone may result in hypokalemia, hyponatremia and dehydration.
Symptoms of low cortisol may include fatigue (particularly morning
fatigue), increased susceptibility to infection, decreased
recovery from exercise, allergies, hypoglycemia, burned out feeling, depression and decreased sex drive.
Why Test Saliva Cortisol?
- Clinicians can often make a diagnosis of adrenal exhaustion
solely on the basis of history and physical examination, but saliva
hormone testing can be useful in the following instances:
- determining whether a patient is in the early stages of resistance.
- confirming suspected adrenal dysfunction.
- helping
to motivate patients to make lifestyle changes. Many people recognize
that they are under stress, but having a comparison to ”normal‘ can be
a strong motivator to learn new coping skills.
- The
diurnal variation of cortisol is readily mapped by using saliva testing
since collection is easy to do at home or at work. Four specimens are
obtained: morning (within first hour of waking), before lunch, before
supper, and before bedtime. The cortisol levels for each point are
graphed according to the reference range for that time period.
- Saliva
is an excellent medium for measurement of cortisol because, unlike
blood and serum where venipuncture can cause an anticipatory rise in
cortisol, collection of saliva does not.
Background on Cortisol
The adrenal glands produce cortisol 24 hours per day with a regular
diurnal variation. Cortisol output is highest within the first hour
after waking, declines steadily through the day, and reaches a low
during sleep. Adrenal exhaustion tends to result in a flattened
cortisol profile with loss of the morning surge, while earlier stages
of the General Adaptation Syndrome generally result in one or more elevated cortisol points.
Background on DHEAS
DHEA, or dehydroepiandrosterone, is also secreted by the adrenal
glands. It is the most abundant steroid hormone in the body,
circulating primarily in its sulphated form, DHEA-S. DHEA competes with
cortisol at the receptor level, and balances the effects of cortisol.
The ratio of cortisol to DHEA tends to increase with age because DHEA-S
declines with age, while morning cortisol stays the same or increases slightly.
A higher than expected ratio for a given age may be indicative of
unbalanced adrenal function (cortisol too high or DHEA-S too low).
Factors contributing to imbalance may include acute or chronic stress,
obesity, metabolic syndrome or diabetes, and hypothyroidism.
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