The Adrenal Stress Index is a comprehensive test that provides your doctor with more information than standard serum and urine test results.

The Adrenal Stress Index can:

  • Help identify possible causes of excessive fatigue
  • Identify underlying reasons for chronic infections including sinusitis and other recurrent respiratory infections
  • Screen for concerns with blood sugar and insulin resistance
  • Help determine if a gluten-free diet may be best for you
  • Identify possible reasons why you may have difficulty falling asleep or staying asleep

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Adrenal Stress Index: Patient Overview

The Diagnos-Techs Adrenal Stress Index (ASI)

is a noninvasive way to evaluate the effects of stress on your body. It includes 10 tests for six different hormones and immune markers that may be affected by chronic stress and stress-related conditions.

The Adrenal Rhythm and Its Importance

The adrenal glands secrete cortisol in a 24-hour cycle (circadian rhythm), with the highest amount released in the morning and the lowest amount released at night. This 24-hour cycle is called the circadian rhythm and is depicted below in Figure 1.

Certain situations such as stressful events, skipping or delaying meals, or sleep disruptions can cause the adrenals to secrete excess cortisol. Abnormal cortisol levels can have widespread effects throughout the body and may contribute to a wide range of health conditions, but treatment options are available if these abnormalities are detected.

Cortisol levels can influence:

Energy Production

Abnormal adrenal function can alter the ability of cells to produce energy for the activities of daily life. People who have a hard time rising in the morning, or who suffer from low energy throughout the day, often have abnormal adrenal rhythms and poor blood sugar regulation.

The maintenance of a stable blood sugar level depends on food choice, lifestyle, adrenal function, and insulin activity. The Adrenal Stress Index panel measures stress hormones and insulin, to help clarify the causes of fatigue, cravings, and obesity.

Immune System Function

Various immune cells (white blood cells) cycle in and out of the spleen and bone marrow. The immune system trafficking follows the cortisol cycle. If the cycle is disrupted, especially at night, then the immune system is adversely affected.

Short- and long-term stress is known to suppress the immune response in the lungs, throat, urinary tract, and intestines. With lowered levels of mucosal antibodies (secretory IgA), our resistance to infection is reduced and allergic reactions may increase.

Skin Integrity

Human skin regenerates mostly during the night. With higher night cortisol values, less skin regeneration takes place. Therefore a normal cortisol rhythm is essential for optimal skin health.

Muscle and Joint Function

Abnormal adrenal rhythms are known to compromise tissue healing. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint wasting with chronic pain.

Bone Health

The adrenal rhythm determines how well we build bone. If the night and morning cortisol levels are elevated, our bones do not rebuild well, and we are more prone to osteoporosis. Stress is the enemy of the bones. In postmenopausal women, the effect of stress worsens due to the naturally lower levels of female hormones.

Allergies/Autoimmune Disorders

More than fifty years ago, Dr. Jefferies (author of Safe Uses of Cortisol) discovered that patients with environmentally triggered allergies and autoimmune diseases dramatically improved when given cortisol for other purposes. More recently, German researchers reported that disruption of the adrenal axis and cytokine relationships lead to predisposition and aggravation of autoimmune diseases. The ASI panel can help identify patients with autoimmune diseases and adrenal problems who may improve with cortisol support.

Sleep Quality

The ability to enter REM sleep cycles and to experience regenerative sleep are interrupted by high cortisol values at night and in the morning. Chronic lack of REM sleep can reduce a person’s mental vitality, vigor, and induce depression.

Thyroid Function

The level of cortisol at the cell level controls thyroid hormone production. Often, hypothyroid symptoms such as fatigue and low body temperature are due to an adrenal maladaptation.

Blood Sugar Regulation

Chronic hypoglycemia can impair normal adrenal function by repetitive overstimulation of cortisol production. Recurring exposure to high cortisol will impair insulin activity and invariably lead to insulin resistance and beta-cell exhaustion (diabetes). The ASI panel investigates the insulin-cortisol relationship under real-life conditions to allow targeted and meaningful interventions. This panel is useful in the following clinical situations: rapid weight gain and obesity, imbalanced blood lipids, sugar blues, early diabetes, and associated emotional disturbances.

Brain Function and Emotional Health

Several recent publications report a hyperactive HPA axis in depressed patients. Elevated midnight salivary cortisol is now considered one of the best tests in diagnosing endogenous depression. Other anomalies in cortisol rhythm usually accompany the midnight elevation. On the other hand, cortisol elevations and rhythm disruptions throughout the day are typical of attention deficit disorders (ADD). The anomalous cortisol findings in depression and ADD can be diagnosed successfully with the ASI panel. Subsequent interventions to rectify specific cortisol elevations (during the day or night) are usually effective when applied under proper supervision.


Five saliva samples are used to assess the following:


Cortisol Evaluate the stress response
Insulin Investigate blood sugar control and insulin resistance
DHEA/DHEA-S Determine how other hormones may be affected by stress
Total secretory IgA (sIgA) Evaluate the toll of stress on immunity
17-OH progesterone Determine underlying causes of abnormal cortisol levels
Gluten antibodies Identify immune response to gluten