Speak the words “adrenal fatigue” to a doctor, and they’ll tell you there’s no such thing. After all, the research shows it does not exist as the internet would lead you to believe. [1] But does that mean patients are making things up? Recent reports show that 5-7% of patients complain about fatigue, with 75-90% having stress-related visits to their doctor. [2] [3] After being turned down by their doctors, people usually go to the internet for more answers. And this is where things get worse. Not only do they start self-diagnosing, but they also get duped by unqualified health “experts” into buying expensive supplements, kits, and protocols to help “cure” their condition. The truth of the matter is that a real adrenal-related condition usually happens in the form of Addison’s disease or, in the case of today’s topic, HPA axis dysregulation (HPA-D for short). [4] HPA-D is an accepted diagnosis, but not many people are aware of its existence or are willing to bring it up to their doctors. After today though, you’ll now know how to do just that!

What is the HPA Axis? 

Be ready for a mouthful! HPA stands for hypothalamic-pituitary-adrenal-axis, which is the body’s central stress response system made of the:

• Hypothalamus: The region of the brain responsible for connecting the nervous and endocrine (hormonal) systems with the pituitary gland (see below). It regulates sleep, body temperature, hunger, thirst, and our emotions. [5]
• Pituitary Gland: Also known as the “Master Gland.” A pea-sized gland located at the base of the brain that regulates the rest of the body’s endocrine glands. [6]
• Adrenal Glands: Two glands located at the top of the kidneys. They produce hormones (cortisol, adrenaline, estrogen), regulate our metabolism and stress response, and affect blood pressure and immune function. [7]

As part of the HPA axis, all three affect hormones, metabolism, immunity, stress, emotional health, and energy. If anything should go wrong with even one of the glands, the rest fall out of alignment. Eventually, the body begins to experience a series of side effects. Anything from infertility to difficulty coping with (and recovering from) stress can take place. But most importantly is the hormonal imbalance.

When it comes to the HPA Axis, there are four hormones to keep in mind. These are:

• Cortisol: We all know this guy- the stress hormone. However, cortisol isn’t necessarily the bad guy. Its core function is to help our body deal with stress. It’s more of a survival hormone if anything. The problem is that many people don’t know how to “tune out” of stress, which is what kicks it into either an overdrive or underdrive (yes, you can have too little cortisol- in fact, the theory of adrenal fatigue is based on low cortisol!). However, cortisol isn’t only triggered by stress. An unhealthy or inflammatory diet can also stimulate it since things like inflammation, poor digestion, and food allergies can all spike it. Cortisol is also a type of hormone known as glucocorticoids; more on that below. [8]
•  CRH (corticotrophin-releasing hormone): Another stress hormone. The hypothalamus releases CRH in order to get the pituitary gland to release another hormone known as ACTH (see below). Similar to cortisol, CRH can either be triggered by external or internal stress. [9]

•  ACTH (adrenocorticotropic hormone): Released by the pituitary gland (thanks to CRH) to stimulate the adrenal glands into producing glucocorticoids (see below). [10]

• Glucocorticoids: Steroid hormones that are involved with immune system regulation and lowering inflammation. [11]

To sum everything up, beginning in the hypothalamus, CRH causes the pituitary gland to release ACTH, which then triggers the production of glucocorticoids (like cortisol) in the adrenals. Ideally, the glucocorticoids will help the body to “deal” with the stress and lower any inflammation caused by it.

The Causes of HPA Axis Dysregulation

If you are feeling unusually tired, exhausted, and more or less beyond the point of “burned out,” there is a chance you may have an imbalance in your HPA Axis. Here are some of the possible culprits behind it:

• Chronic (i.e., months, if not years) of extreme, constant stress combined with a poor way to handle it
• Transition into menopause
• Premature menopause
• Birth control
• Hormone therapy
• Poor sleep (not just for a short while but happening for a long time)
• Estrogen dominance or excess
• Pregnancy and postpartum
• Stressful events (divorce, death, breakups, losing a job, separation, abuse, etc.)
• PTSD
• Overworking
• Excessive exercise (causing overtraining)
• Thyroid disorders (hyperthyroid, hypothyroid)’
• PCOS (polycystic ovarian syndrome)

[12] [13] [14]

It’s All About Stress

As you can see, anything that affects the hormones is going to eventually change the HPA Axis, especially the longer it goes unmanaged. However, the main trigger of HPA-D would have to be stress. According to functional medicine practitioner Dr. Jill Carnahan MD, “The concept of adrenal fatigue is that cortisol gets stuck switched on, which eventually wears out the adrenals. But the problem with this is that many people who believe they have adrenal fatigue often don’t have dysfunctional cortisol levels. Scientific literature backs this up… However, HPA axis dysfunction, which is an alteration in stress response over time (after exposure to chronic stress), has been verified and associated with numerous diseases. In summary, HPA axis dysfunction is something we could work to understand a little better but in the meantime, the existence of the HPA axis dysfunction suggests that we need to take reducing stress very seriously.” [15]

If you think you live a stress-free life, look beyond the common causes, such as relationship problems, work, home life, and money.

There could be hidden sources such as clutter, social media, mindset, and stretching yourself too thin (more on these here). If you’re an athlete, it may be poor recovery. Are you recovering just as hard as you’re working out? If not, then you could be overtraining, which leads to injuries, inflammation, weak immunity, and yes, hormone imbalances.

Other causes of fatigue include nutrient deficiencies (b vitamins, iron, electrolytes), poor gut health, drinking too much caffeine, medications, or a lack of exercise. And let’s not forget sleep. How many hours of sleep a night are you getting? Not only that, but how is the quality? Are you spending time on social media or watching TV? Is your bedroom completely dark? Do you live in a noisy area? Are you overexposed to blue light? (To see how you can improve your sleep, check this post out here.) Maybe your body needs real, proper rest!

A real adrenal disorder would result in a severe condition like Addison’s disease, in which case your doctor can properly treat and diagnose you. Otherwise, look for the hidden causes behind your exhaustion. Is it stress, poor sleep, environment, or lifestyle? When in doubt, go and get yourself checked out by your doctor. Have them do a thorough check of your hormones as well as general bloodwork. You can also work with a functional medicine practitioner; they’ll have a more holistic, lifestyle-based approach to your health.

Sources:

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997656/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519220/
[3] http://www.stress.org/americas-1-health-problem/
[4] https://academic.oup.com/jcem/article/86/8/3545/2848467
[5] https://www.healthline.com/human-body-maps/hypothalamus
[6] https://www.medicinenet.com/script/main/art.asp?articlekey=4915
[7] https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands
[8] https://healthcare.utah.edu/healthfeed/postings/2017/10/cortisol.php
[9] https://www.medicinenet.com/script/main/art.asp?articlekey=18685
[10] https://medlineplus.gov/lab-tests/adrenocorticotropic-hormone-acth/
[11] https://www.brainfacts.org/thinking-sensing-and-behaving/emotions-stress-and-anxiety/2012/stress-the-role-of-glucocorticoids
[12] https://www.integrativepro.com/Resources/Integrative-Blog/2017/Women-Stress-Changes-Cause-HPA-Axis-Dysregulation