Conceptual Framework of Adrenal Stress Index
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Test Description

Adrenal Stress Index - ASI Panel
A saliva test to assess the free Bioactive cortisol rhythm and DHEA.
Also includes Total Secretory IgA and Gliadin Antibody measurements.

The Adrenal Stress Index (ASI) panel
includes the following components:
I. The Cortisol Rhythm - Temporal Adrenal Profile
A Temporal Adrenal Profile (TAP) which measures the fluctuations of salivary cortisol during a circadian cycle (Figure 1- to be added). This dynamic assessment, using four saliva samples, allows the evaluation of hypothalmic-adrenal function and rhythm under real life conditions.
The Circadian abnormalities observed help diagnose subtle and often undetected problems, as in glycemic dysregulation or pituitary lesions.
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ASI Panel Includes (continued)
II. Dehydroepiandrosterone & (DHEAS)
DHEA & DHEA(S) determination from pooled samples which reflects the time averaged adrenal capacity to produce androgens. At some point during chronic stress, androgen output may decrease while cortisol levels increase. This altered response to endogenous ACTH is clinically significant. A graphical correlation between salivary free cortisol (FC) and DHEA(S) levels (Figure 2- to be added), allows differentiation of normal, adapted, and maladapted stress response patterns. Abnormal patterns are associated with several diseases and dysfunctions that include the following:
· Psychosomatic DiseasesXXXXXX· Chronic Fatigue Syndrome
· Stress Induced DiseasesXXXXXX · Chronic Depression
· OsteoporosisXXXXXXXXXXXX· Hypoglycemia
· InsomniaXXXXXXXXXXXXXX· Reduced Immunity/Chronic Infections
· Hypo & Hyper Adrenal FunctionXI· Stress Response Evaluation to Exercise

III. Intestinal Secretory IgA & Component
Total Secretory IgA (SIgA) determination from saliva is used in the clinical evaluation of the effect of stress on immunity. SIgA is a direct marker of cortisol induced immunosuppression and an indirect marker of sympathetic to parasympathetic balance. SIgA levels have additional relevance in the management of external stressors such as food intolerance, chronic parasitic, fungal and viral infections.

ASI Panel Includes (continued)
IV. The Gliadin Antibody
Secretory anti-Gliadin antibody (GL-Ab) titer from saliva is a screening test intended to detect active, subclinical or latent Gliadin (from grains) intolerance. This is a powerful Stressor that afflicts 12%-14% of the US population and exerts ongoing inflammatory stress on the Adrenal Axis.

V. ACTH-Adrenocorticotropin
The purpose of introducing matched ACTH/cortisol testing is to make HPA axis diagnosis more definitive. The stress hormone ACTH secreted from the pituitary gland is released in response to hypothalmic CRF Corticoptropin Releasing Factor.CRF activity is derived from vasopressin, CRF-41 polypeptide, and other components acting synergistically to actuate ACTH synthesis and release.

ACTH action
ACTH exerts influence on the adrenal cortex through several mechanisms:
1. Enhanced cholesterol metabolism
2. Increased Pregnenolone synthesis
3. Regulation of the steroid synthesis pathway

Adrenal Axis Stress
ACTH is itself a stress hormone in lieu of its cortisol output enhancement. Thus, even in the absence of increased cortisol due to adrenal dysfunction, high ACTH has its own impact on bodily function. Increased ACTH coupled with a hyperproduction of cortisol leads to synergistic enhancement of the stress response. Example: Increased ACTH and subsequent cortisol output increase synergistically promote catecholamine synthesis. This leads to a hightened sympathetic response to stressors.

ASI Panel Includes (continued)
ACTH and Cortisol Measurements
In cases where there is a need to differentiate between central and/or peripheral dysfunction,
the ACTH measurements are performed and allow differential diagnosis of primary and
secondary Thyroid disease.

*Low Cortisol Output
Two scenarios may emerge:
I. Low Cortisol Output Central
Low ACTH Dysfunction

II. Low Cortisol Output Peripheral Dysfunction
High ACTH Adrenal Glands are the problem

*High Cortisol Output
Two scenarios may emerge:
I. High Cortisol Output Stress Response
High ACTH Normal Course

II. High Cortisol Output Possible Adrenal
Normal or Low ACTH hypertrophy

ASI Panel Includes (continued)
*Normal Cortisol Output
I. Normal Cortisol Output Optimal
Normal ACTh

II. Normal Cortisol Output Suboptimal gland response
High ACTH Adrenal Maladaption
Inherent low adrenal reserve

Saliva Measurements
Diagnos-Techs has perfected the measurement of salivary analytes over the past decade. ACTH in saliva is the free Fraction (bioactive) hormone. It is reflective of pituitary pacing of the gland. The salivary ACTH test developed at our laboratory is 1000 times more sensitive than serum testing.

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