Stages, Tests and Treatment

Stages

Adrenal exhaustion progresses in three (3) stages. Adrenal Function Testing is the most accurate determination of which stage you may find yourself.

Stage I Alarm is distinguished by an increase in output of ACTH by the anterior pituitary gland, increased adrenocortical stimulation, increased cortisol output and an increased probability of pregnenolone steal and decreased DHEA. When in a Chronic Stress Response, pregnenolone, the common precursor to cortisol, DHEA and other hormones is preferentially diverted to cortisol production at the expense of the rest of the steroidal hormones. Generally in Stage I cortisol increases and DHEA and its metabolites decrease or an imbalance occurs especially between testosterone and estrogen.

Increased ACTH and Cortisol. Decreased DHEA. Estrogen and Testosterone imbalance.

Stage II Resistance Adrenal Exhaustion is marked by the transition from increased to decreased cortisol output. This stage is characterized by continuing high levels of ACTH and thus: adrenocortical stimulation, normal total cortisol output, low or borderline low morning, noon or afternoon cortisol levels, normal nighttime cortisol level, and an increased probability of pregnenolone steal and a further decrease in DHEA. This is a transitional phase in which although ACTH stimulation remains high or even increases, the adrenal output of cortisol declines due to the adrenal fatigue associated with continued hyper stimulation.

Increased ACTH. Decreased DHEA and Cortisol. Cortisol rhythm disturbance.

Stage III Failure Adrenal Exhaustion is an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. This stage is characterized by continuing high levels of ACTH and thus adrenocortical stimulation, low total cortisol output, and increased probability of a low nighttime cortisol level and pregnenolone steal and even further decrease in DHEA. The adrenal glands are now exhausted to the point that even though there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are unable to return the system to homeostasis.

Increased ACTH. Decreased DHEA and Cortisol. Cortisol rhythm disturbance; especially at night

FUNCTIONIONAL ADRENAL TESTS

Adrenal Function Tests You Can Do at Home

#1-Postural Hypotension:
Postural hypotension (also known as orthostatic hypotension) is a drop in blood pressure that occurs upon rising from a horizontal position. It is commonly expressed as a feeling of dizziness or lightheadedness, a "head rush", or "standing up too fast".

To do this test, you will need a blood pressure cuff. Lie down and rest for 5 minutes. Take a blood pressure reading while still horizontal. Then, stand up and take another reading.

Normally, your blood pressure should rise 6-10 points. If it drops, particularly by 10 points or more, hypoadrenia is indicated. Generally, the bigger the drop, the greater the adrenal insufficiency.

It should also be mentioned that low blood pressure in general is also an indicator of exhausted adrenals when present in conjunction with the other symptoms of adrenal gland fatigue.

#2-Iris Contraction Test
For this test you will need a weak flashlight or penlight, and a mirror. In a dark bathroom or closet, wait a minute for your eyes to adjust to the dark. This will allow your pupils to dilate (open) fully. Then, shine the flashlight into your eyes, and watch the reaction of your pupils for at least 30 seconds.

The light should cause your iris to contract, making your pupils (the dark spot in the center of your eye) smaller. Normally, they should stay that way, but if you have adrenal gland fatigue, the iris will be weak and will not be able to hold the contraction, it will either waver between contracted and relaxed, or will contract initially, but then open up after 10-30 seconds.

As with the postural hypotension test, the degree to which you "fail" this test is an indicator of the degree of adrenal insufficiency you are experiencing.

#3-Sergent's Adrenal White Line
With your fingernail or the dull end of a spoon, draw a line across your belly. In moderate to severe cases of adrenal fatigue, the line will stay white, and even get wider over the course of time, while a "normal" reaction would be for the line to almost immediately turn red.

This test has historically been used to indicate severe adrenal fatigue and Addison's Disease, milder cases of adrenal fatigue may not exhibit this sign.

Saliva Testing

What is Saliva Testing?

The Cortisol/DHEAS Saliva Test measures the levels of the stress hormones DHEAS and cortisol and provides an evaluation of how cortisol levels differ throughout the day.

Health conditions this test is used to assess
Most saliva hormone tests can uncover biochemical imbalances that can be underlying causes of such conditions as chronic stress, adrenal fatigue, anxiety, chronic fatigue, obesity, diabetes, depression, insomnia, and many other chronic conditions.

What does this test involve?
The test involves simply spitting into a test tube. Cortisol is measured four times - in the morning (8 AM), noon, evening (4 PM) and night (best between 11 PM and midnight). Other steroid hormones, such as estrogen, progesterone, DHEAS and testosterone can be measured along with cortisol in the 8 AM saliva sample, if desired. You carry the test tubes with you during the day (they easily fit into a pocket or purse) so they are handy when it’s time to give a saliva sample. Immediate refrigeration is not necessary. Once the sample set is complete, you mail the tubes back to the lab for analysis in the mailing envelop that is included with the test kit. Both you and your doctor will receive copies of the results, usually within 2 weeks.

Is saliva testing for hormones reliable?
Yes, saliva tests are reliable indicators for all steroid hormones (cortisol and all sex steroids). However just as with blood tests, some labs are more reliable than others – especially for sex steroids, like estrogens. In fact, saliva cortisol testing is covered by Plan B medicare. The National Institutes of Health (NIH) and the World Health Organization (WHO), recognize saliva cortisol testing as being very accurate. Some insurance plans also cover saliva cortisol testing. Since 1983, 2,500 research papers have been published supporting salivary hormone testing.

How can I get this test done?
Talk to your health care professional about your symptoms and ask if this test would be useful for you.

The following laboratory performs salivary hormone testing and can help you find practitioners who are familiar with them:

Diagnos-Techs, Inc.6620 192nd Place, Bldg. J
Kent, WA 98032
425-251-0596
e-mail cs@diagnostechs.com


Treatment

Too often the signs and symptoms of the adrenal cortex are confused with those created by the adrenal medulla and a sympathetic - parasympathetic nervous system imbalance.' On the "Stress Related Illness and the Adrenal Glands" chart is a listing of common signs and symptoms found in stress related patients with a differentiation made between those arising from the adrenal cortex and those attributable to sympathetic - parasympathetic imbalance. It is important to identify whether or not the stress related patient is either sympathetic dominant or parasympathetic dominant because treatment must be varied accordingly.

Sympathetic Dominance Signs

• High Systolic / High Diastolic
• Tachacardia
• Paradoxal pupils
• Energy OK
• Closed ICV
• Decreased Saliva

Parasympathetic Dominance signs

• Low Systolic
• Bradycardia
• Constricted Pupils
• ICV Open
• Energy Low
• Increased Saliva

HyperAdrenal Cortex Signs

• High Diastolic

HypoAdrenal Cortex Signs

• Low Diastolic
• Increased Pulmonary S2

Nutritional Support:

Drenamin is a combination product containing adrenal protomorphogen extract, adrenal concentrate, and the Cataplex "G" (riboflavin and niacin) and Cataplex C. The adrenal gland has both a cortex and a medulla. Drenamin helps to support primarily adrenal cortex function. The adrenal gland cortex is an endocrine gland which makes steroid hormones which are increased under conditions of stress and whose effects last for several hours. It is sometimes necessary to use the protomorphogen extract in combination with the whole glandular concentrate which is supportive of both the cortex and the medulla. The Cataplex "G" and C are substances which the adrenal cortex uses up. Drenamin is important to consider in a patient whose nutritional pattern has been faulty for a long time.

Drenatrophin PMG supports adrenal function. Provides uniquely derived nucleoprotein-mineral extracts that support cellular health. Supports adrenal gland health. Over the long term, helps maintain adrenal function to reduce the effects of stress on the nervous system and combat fatigue.
 
A flexible rule of thumb would be to use Drenamin for patients with high or normal blood pressure and weak adrenals, and Drenatrophin PMG for patients with low blood pressure and weak adrenals.

Frequently, Pantothenic acid (B5) is also required in stress related conditions. Pantothenic acid is essential for the synthesis of steroid hormones in the body including the adrenal hormones. In most patients, 100 mg to 300 mg. of pantothenic acid per day is adequate to combat their stress levels when combined with other natural therapies.

Too often the signs and symptoms of the adrenal cortex are confused with those created by the adrenal medulla and a sympathetic - parasympathetic nervous system imbalance.

The body makes norepinephrine and epinephrine using the following nutrients: the amino acid Tyrosine, Tyrosinase Enzyme and Ascorbic acid (as in CATAPLEX C), Folic Acid, B-6, Niacinamide, and Iron.

Alkaline ash minerals will affect tissue response in such a way as to enhance parasympathetic and dampen sympathetic dominance. The alkaline ash minerals, as found in Organically bound minerals enhance the parasympathetic nervous system which is the body's brake. Alkaline ash minerals are predominantly potassium and magnesium but thi products also contain calcium and a number of other minerals. organically bound minerals tablets are a particularly good source of magnesium, not so much in quantity, but in function in the body. They are also an excellent source of potassium. The potassium, magnesium, and other alkaline ash minerals found in organically bound minerals come primarily from green leafy vegetables. In general, alkaline ash minerals are found in fruits and vegetables.

Herbs

Rehmannia
Rehmannia is the most important Chinese herb for disorders of the kidneys and adrenal glands. Rehmannia also appears to combat adrenal suppression caused by steroid hormones and has a similar tonic effect on the adrenal cortex as licorice. Unlike liquorice (also an adrenal tonic), rehmannia is suitable for use in patients with hypertension (high blood pressure).

Licorice
Its affinity for the endocrine system makes licorice a most remarkable herb, which when used judiciously can be very helpful in treating many human ailments. Licorice has an anti-inflammatory, antiallergic and antiarthritic effect similar to that of cortisone but without its side effects. This is because of glycyrrhizin which has a structure similar to hormones produced by the adrenal glands (cortisol). This occurs because licorice slows the breakdown of cortisol produced by the body.

Adaptogens

The term adaptogen is used by herbalists to refer to natural herb products which they believe increase the body's resistance to stress, trauma, anxiety and fatigue. Adaptogens can also be called rejuvenating herbs, qi tonics, rasayanas, or restoratives. One specific characteristic of their action is that their effect is believed to help the body return to a balanced state. Some herbologists claim that adaptogenic herbs are distinct from other substances in their ability to balance endocrine hormones and the immune system, and they help the body to maintain optimal homeostasis. Adaptogens are purported to have a normalizing effect on the body and to be capable of either toning down or strengthening the activity of hyperfunctioning systems.

Withania (Ashwaganda) Complex
An effective combination of Ashwaganda (Withania), Skullcap, Licorice and Korean Ginseng to support both adrenal and nervous system health. A wonderful whole body tonic to promote vitality and stamina in people of any age. The combination of adrenal and nervous system support helps to promote relaxation and the body's ability to adapt to temporary stress. Supports HPA axis. Specialized testing techniques used by MediHerb ensure that the correct plant parts containing appropriate levels of active constituents are used, which is particularly important for both Ashwaganda and Korean Ginseng.

Eleuthero
An effective herb revered in Russia to support the body's ability to adapt to temporary stress. Supports the HPA axis. Eleuthero has been shown to restore and enhance immune system function. A wonderful whole body tonic that promotes vitality, and physical and mental endurance. MediHerb's Eleuthero contains 950 mcg of eleutheroside E to ensure quality and optimal clinical results.

Rhodiola and Ginseng Complex
Combines two powerful tonic herbs, Rhodiola and Korean Ginseng, to promote energy, vitality and stamina. Ideal formula to support physical and mental performance. Korean Ginseng and Rhodiola contain guaranteed levels of active constituents to ensure optimal quality and clinical results.

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