Adrenal Function Panel

The Adrenal Function Panel is one method for measuring ability to cope with stress. Basically, a stressor induces neuroendocrine cells to release corticotropin releasing factor (CRF), which stimulates release of adrenocorticotropic hormone (ACTH) and triggers cortisol release. Prolonged exposure to stressors may result in what Dr. Hans Selye called General Adaptation Syndrome, which consists of three major stages of adaptation to stress.

General Adaptation Syndrome

  • Alarm Stage
    In response to a stressor, the adrenal glands release adrenaline and noradrenaline along with cortisol and DHEA. Increased levels of these hormones enable the body to mount a response to the stressor. This results in the traditional —fight, flight or freeze“ response.
  • Resistance Stage
    During this stage, higher than normal levels of cortisol stimulate the conversion of proteins, fats and carbohydrates into energy, helping the body adapt to stress. However, a lengthy Resistance Stage is maladaptive, as sustained cortisol elevation increases the risk of developing stress related diseases. Symptoms of elevated cortisol may include: feeling tired but wired, difficulty sleeping, and anxiety. Excess cortisol can interfere with the action of progesterone
    and testosterone at receptor sites and could lead to symptoms of hormone imbalance.
  • Exhaustion Stage
    At this stage, the adrenal glands are no longer able to mount a suitable response to stress. Depletion of the adrenal glands reduces production of cortisol, DHEA and aldosterone. DHEA levels likely decrease first, but deficiency symptoms are not well defined. Lack of aldosterone may result in hypokalemia, hyponatremia and dehydration. Symptoms of low cortisol may include fatigue (particularly morning fatigue), increased susceptibility to infection, decreased
    recovery from exercise, allergies, hypoglycemia, burned out feeling, depression and decreased sex drive.

Why Test Saliva Cortisol?

  • Clinicians can often make a diagnosis of adrenal exhaustion solely on the basis of history and physical examination, but saliva hormone testing can be useful in the following instances:
    • determining whether a patient is in the early stages of resistance.
    • confirming suspected adrenal dysfunction.
    • helping to motivate patients to make lifestyle changes. Many people recognize that they are under stress, but having a comparison to ”normal‘ can be a strong motivator to learn new coping skills.
  • The diurnal variation of cortisol is readily mapped by using saliva testing since collection is easy to do at home or at work. Four specimens are obtained: morning (within first hour of waking), before lunch, before supper, and before bedtime. The cortisol levels for each point are graphed according to the reference range for that time period.
  • Saliva is an excellent medium for measurement of cortisol because, unlike blood and serum where venipuncture can cause an anticipatory rise in cortisol, collection of saliva does not.


Background on Cortisol

The adrenal glands produce cortisol 24 hours per day with a regular diurnal variation. Cortisol output is highest within the first hour after waking, declines steadily through the day, and reaches a low during sleep. Adrenal exhaustion tends to result in a flattened cortisol profile with loss of the morning surge, while earlier stages of the General
Adaptation Syndrome generally result in one or more elevated cortisol points.


Background on DHEAS

DHEA, or dehydroepiandrosterone, is also secreted by the adrenal glands. It is the most abundant steroid hormone in the body, circulating primarily in its sulphated form, DHEA-S. DHEA competes with cortisol at the receptor level, and balances the effects of cortisol. The ratio of cortisol to DHEA tends to increase with age because DHEA-S declines
with age, while morning cortisol stays the same or increases slightly. A higher than expected ratio for a given age may be indicative of unbalanced adrenal function (cortisol too high or DHEA-S too low). Factors contributing to imbalance may include acute or chronic stress, obesity, metabolic syndrome or diabetes, and hypothyroidism.

 

Cortisol Graph Lifestyle Issues
 Supplements to Consider
  • Reduce stress and/or improve coping skills
  • Get adequate sleep
  • Eliminate caffeine
  • Reduce consumption of refined carbohydrates as they raise insulin levels, which lowers glucose, which triggers release of more cortisol (to raise glucose) 

For Alarm Resistance Stage:

  • B-complex vitamins
  • Vitamin C
  • Magnesium
  • Calcium
  • Pantothenic acid
  • Trace Minerals
    • Zinc
    • Magnesium
    • Selenium
    • Molybdenum
    • Chromium
    • Copper
    • Iodine
  • Vitamin E
  • Adaptogens
    • Ashwaganda
    • Schisandra
    • Rhodiola
    • Cordyceps
    • Panax ginseng
    • Eleuthero
  • Magnolia officinalis, alone or in combination with other adrenally acting herbs
  • Phosphatidylserine
  • Omega-3 fish oils
  • Phytosterols (beta-sitosterol)
  • Theanine
  • Tyrosine
  • Phenylalanine
  • Methyl donors: MSM, SAMe, betaine
  • Vitamins and trace minerals are required as cofactors in the synthesis of adrenal hormones.  Excess stress can increase requirements for these nutrients.
  • Adaptogens help the body adapt to high or low cortisol levels.  They are helpful for all stages of the General Adaptation Syndrome.
  • Magnolia helps bring down salivary cortisol levels and may have anxiolytic properties.
  • Phosphatidylserine may help modulate elevated cortisol levels, particularly after exercise.
  • Omega-3 fish oilinhibits adrenal activation elicited by mental stress
  • Phytosterols help balance the ratio of cortisol to DHEA.
  • Theanine assists the brain in dealing with stressful events.
  • The amino acids phenylalanine and tyrosine may accelerate the synthesis of adrenaline and noradrenaline.
  • Methyl donors may help lower cortisol levels by assisting in the conversion of noradrenaline to adrenaline.
  • A noon cortisol that is less than 40% of morning cortisol is suggestive of adrenal dysfunction even if points are within normal range.
  • Reduce stress and/or improve coping skills
  • Get adequate sleep
  • Eliminate caffeine
  • Reduce consumption of refined carbohydrates as they raise insulin levels, which lowers glucose, which triggers release of more cortisol (to raise glucose) 
  • Patient experiences a ”rebound‘ in the afternoon 
  • Reduce stress and/or improve coping skills
  • Get adequate sleep
  • Eliminate caffeine
  • Reduce consumption of refined carbohydrates as they raise insulin levels, which lowers glucose, which triggers release of more cortisol (to raise glucose)
  • Afternoon rise in cortisol may be due to increased activity or stress. E.g. driving home, exercise, eating.
  • Reduce stress and/or improve coping skills
  • Get adequate sleep
  • Eliminate caffeine
  • Reduce consumption of refined carbohydrates as they raise insulin levels, which lowers glucose, which triggers release of more cortisol (to raise glucose)
  • High evening cortisol along with low DHEAS has been associated with increased breast cancer risk.
  • Reduce stress and/or improve coping skills
  • Eliminate caffeine
  • Reduce consumption of refined carbohydrates as they raise insulin levels, which lowers glucose, which triggers release of more cortisol (to raise glucose)
  • Reduce stress and/or improve coping skills
  • Get adequate sleep; may need to sleep later in morning
  • Eliminate caffeine
  • Reduce consumption of refined carbohydrates as they raise insulin levels, which lowers glucose, which triggers release of more cortisol (to raise glucose)
  • Glass of salt water in the morning (use sea salt to taste)
  • Mild to moderate exercise only 
  • Avoid potassium rich foods first thing in morning
  • Adrenal gland concentrates are used on the assumption that naturally occurring precursors and polypeptides support the function of the hypothalamus and adrenals.
  • Adrenal support vitamin/minerals:
    • B complex
    • High dose Vitamin C
    • Pantothenic acid
    • Calcium & Magnesium
    • Mixed tocopherols
  • Adaptogens such as:
    • Panax ginseng
    • Rhodiola Ginseng
    • Ashwaganda
    • Schisandra
    • Cordyceps
  • Short-term supplementation with cortisol and intravenous trace element infusions may be required in some cases. (see The Safe Uses of Cortisol by William Jeffries)