The adrenals are two small glands, each weighing 3 to 5 grams, that are located above the kidneys. The adrenals have one of the highest rates of blood flow per gram of tissue, and the highest content of vitamin C per gram of any tissue in the body.

Each adrenal gland is composed of two separate functional entities. The outer zone, or cortex, accounts for 80-90% of the gland and secretes adrenal steroids (cortisol, DHEA-S and aldosterone). The inner zone, or medulla, comprises 10-20% of the gland and secretes the catecholamines (adrenaline and nor-adrenaline). Cortisol, DHEA and adrenaline are the three main adrenal stress hormones.

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Adrenal Stress Index™: Patient Overview

The Adrenal Rhythm and Its Importance

The human adrenal glands do not secrete steroid hormones at a constant level throughout the day. The hormones are actually released in a cycle, with the highest value in the morning and the lowest value at night when functioning properly. This 24-hour cycle is called the circadian rhythm and is depicted below in Figure 1. An abnormal adrenal rhythm can influence many functions of the body, some of which are described below.

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 ferret out the causes of fatigue, cravings and obesity.

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 female hormone imbalances.

Immune Health

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 reduction in the surface antibody (called secretory IgA), the resistance to infection is reduced and allergic reactions are believed to increase.

Sleep Quality

The ability to enter REM sleep cycles and experience regenerative sleep is 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.

Skin Regeneration

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.

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.

Grain Intolerance and Stress Response

Approximately 12-18% of the U.S. population suffers from a genetic intolerance to grains, such as wheat, rye or barley contained in cereals, breads and pasta. A high incidence occurs in people with Celtic, Nordic, non-caucasian and Mediterranean ethnicity. The gut becomes inflamed within 30 minutes after consuming grains, and this can lead to an adrenal stress response, increased cortisol and reduced DHEA.

Chronic Fatigue Syndrome (CFS)

A common HPA axis defect in CFS is impaired corticotrophin release. As a result, low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with flat rhythms are often seen on the ASI™ panel. Simultaneous use of several therapies can help improve the debilitating effects of CFS.

Glycemic Dysregulation

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, deranged blood lipids, sugar blues, early diabetes and associated emotional disturbances.

Allergies/Autoimmune Disorders

More than fifty years ago, Dr. W. Jefferies (author of Safe Uses of Cortisol) discovered that patients with environmentally triggered allergies and autoimmune diseases dramatically beneﬁted 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 ﬁndings of the ASI™ help identify patients with autoimmune diseases and adrenal problems who can beneﬁt from cortisol supplements.

Depression/ADD

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™. Subsequent interventions to rectify the time-speciﬁc cortisol elevations (during the day or night) are usually effective when applied under proper supervision.