There’s a good chance you have probably heard of Adrenal Fatigue, but I find that the name is incredibly misleading. You see, your adrenals don’t actually get tired or burned out as some might assume. What really happens is there is a breakdown in function or communication in the part of your endocrine system known as the HPA axis.  HPA Axis dysfunction is a less common but more accurate description of what is really going on.

 

What is the HPA Axis?

HPA stands for the hypothalamus, pituitary, and adrenals, three very important endocrine glands. Axis is the term used to represent the interaction between them. This axis plays a very important role in the stress response. 

The hypothalamus is a small region of the brain that detects physical and emotional stress (among other things). It then sends a message to the pituitary via the hormone Corticotropin Releasing Hormone (CRH) to secrete yet another hormone called Adrenocorticotropic releasing hormone (ACTH). ACTH is sent to the adrenal glands to tell them to secrete hormones called glucocorticoids. Among the glucocorticoids is the hormone Cortisol. When things are functioning properly, the hypothalamus detects cortisol levels and will either increase or decrease the messages it sends out to trigger the production of more cortisol.

The role of cortisol in the body

Cortisol in moderation is a good thing. It’s kind of like our “get up and go.” It also keeps us running during stressful situations by downregulating our non-essential functions (ie reproduction, digestion, inflammation) and channeling that energy into life-saving “fight or flight” activities such as mobilizing sugar into the blood for quick energy, raising blood pressure and heart rate to send blood to the extremities to prepare for fleeing. This is good if we are under a true immediate threat. However, cortisol in excess over long periods of time can start to break the body down and cause a host of strange symptoms. More on that later. 

 

Adrenal Fatigue vs. HPA axis Dysfunction

The thing about the hypothalamus is that it doesn’t distinguish between physical, mental, and emotional stress and always responds in the same manner. Well, stress comes in a lot of forms and it comes in hot, almost all day every day. This means that the hypothalamus is frequently telling the pituitary to tell the adrenals to produce more cortisol. 

The adrenal fatigue theory determined that the adrenals, over time, became overworked and eventually “fatigued” and couldn’t produce cortisol at a normal rate. This led to symptoms such as extreme fatigue, lethargy, depression to name a few. Later discoveries have shown that this may not be the case. Instead, there is an alteration in your stress response over time that results in your body becoming desensitized to stress hormones. So, the hypothalamus’ gauge of cortisol levels in the body is off and it no longer triggers the production of the appropriate amount. 

 

Symptoms of HPA Axis dysfunction

Regardless of what you call it, the symptoms of HPA Axis dysfunction or adrenal fatigue aren’t fun.  Here are a few common signs and symptoms:

Fatigue

Dizziness (especially when going from sititng to standing)

Mild depression or anxiety

Hair loss

Brain fog

Compromised immune system (frequent illness)

Low blood sugar

Low body temperature

Cravings for salty foods

Symptoms and their severity may vary from person to person, but if you have gone through a significant stressful period of time and begin to develop symptoms in the months following, then you might suspect HPA axis dysfunction. 

 

Self-tests for HPA Axis dysfunction

The best way to tell if you have HPA axis dysfunction is to work with an experienced practitioner who will test your stress and other hormones and give a detailed interpretation of the results. However, there are a couple of things you can do at home to see if you might have HPA Axis dysfunction.

 

Testing orthostatic blood pressure (Ragland’s sign)

This test involves measuring your blood pressure while lying down and then immediately after standing up. In healthy individuals, blood pressure will rise to accommodate the change in position when a person stands. When HPA axis dysfunction is present, the blood pressure response may be hindered. 

You will likely need another person to help you perform this test by measuring your blood pressure in different positions.

1. ) Take a blood pressure reading as you are seated upright in a chair or on an exam table. Record systolic and diastolic readings. This will act as your baseline. 

2.) Next, lie down on your back. Wait a few minutes to allow your body to acclimate to the new position and then measure your blood pressure lying down.  Record systolic and diastolic readings. 

3.) With the blood pressure cuff still on your arm, stand up and immediately and measure your blood pressure again.  It is important that the reading is taken very quickly after you stand. Record the systolic and diastolic readings. 

What to look for: 

In a healthy person, blood pressure should decrease when going from sitting to lying down.  Blood pressure should increase 6-10mm Hg when going from lying to standing. If blood pressure drops when going from lying to standing, then it is a sign of possible HPA Axis dysfunction. The higher the drop in blood pressure, the more pronounced the dysfunction might be. 

 

Pupil dilation test

Stand in front of a mirror and shine a flashlight into one eye. Continue to shine the light while observing pupil constriction and dilation in the mirror.  If after 30 seconds, your pupil dilates then it may be a sign of decreased adrenal output. The reason this happens is that adrenal insufficiency often causes a deficiency of sodium and an abundance of potassium. The imbalance of the two inhibits the activity of the sphincter muscles in the eye decreasing their ability to contract as they normally would in the presence of bright light.

 

I hope this has given you some insight into some of the symptoms you might be experiencing so you can begin your healing process.  I’m not opposed to calling it adrenal fatigue because after all, it’s just a name. But, I am opposed to focusing solely on one particular organ or gland. It is vital that we acknowledge and address the function of the whole system to truly help the body heal.  

To learn more about how to heal HPA Axis dysfunction naturally and what not do to if you have HPA Axis dysfunction check out my other posts:

 

How to Heal HPA Axis Dysfunction Naturally

What Not To To If You Have HPA Axis dysfunction

 

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