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Adrenal Dysfunction Copyright © 2020 All rights reserved. Neither this document nor any part of it may be reproduced or transmitted in any form or by any means including photocopying, email, fax, etc. without prior written permission of the author. Adrenal Dysfunction Advanced Clinical Focus: Hormones and Endocrinology Adrenal Hormones • Adrenal hormones are the major response of the body to stress or trauma from outside or within. Advanced Clinical Focus: Hormones and Endocrinology Cortisol Steal • Stress = ↓ed steroids X X Advanced Clinical Focus: Hormones and Endocrinology Stress • A state of threatened homeostasis (physical or perceived) • Anything that elevates ACTH or cortisol Advanced Clinical Focus: Hormones and Endocrinology Homeostasis • Described by Walter Cannon • Coordinated physiological processes which maintain most of the steady states in the organism Endocrine System Advanced Clinical Focus: Hormones and Endocrinology Stressors Mental Emotional Spiritual Chemical Physical Advanced Clinical Focus: Hormones and Endocrinology Response to Danger • Freeze: ↑ed sensory acuity • Flight: escape, ↑ed blood to muscle • Fight: can’t escape • Fright: tonic incapacitation • Faint: no more resources Bracha, SH. Freeze, Flight Fight, Fright, Faint: Adaptionist Perspectives on the Acute Stress response Spectrum CNS Spectr. 2004;9(9):679‐685 Advanced Clinical Focus: Hormones and Endocrinology Responses Fear Love • Stimulates SNS • Stimulates the PNS • Activates adrenals • Adrenal-lowering hormones • Arousal of immune • Sleep • Shuts down reproduction • Reproductive hormones Lipton, B. The Biology of Belief, 2011 Advanced Clinical Focus: Hormones and Endocrinology Functions of Cortisol • Stims liver amino acids → glucose • Stims ↑ed glycogen in liver • Mobilizes fatty acids in blood • ↑s coagulation • Suppresses parts of inflammation • Prevents Na loss • Affects mood Advanced Clinical Focus: Hormones and Endocrinology Functions of Cortisol: Prolonged • Stims fat deposits • ↑ed BP • ↑ed protein breakdown • Demineralization of bone • Suppress immune • Memory loss • Depression • ↑ed blood sugar Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome • Stage 1: Alarm/Arousal • Stage 2: Resistance/Adaptation • Stage 3: Exhaustion Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome • Stage 1: Alarm/Arousal • Cortisol and DHEA increase with episodic stress • Recovery to baseline • Asymptomatic Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome • Stage 2: Resistance/Adaptation • Cortisol chronically elevated • DHEA declines • “Stressed”, anxiety attacks, mood swings, depression Advanced Clinical Focus: Hormones and Endocrinology Selye’s General Adaption Syndrome • Stage 3: Exhaustion • Adrenal insufficiency • Low cortisol and DHEA • Depression and fatigue • “Burnt out” Advanced Clinical Focus: Hormones and Endocrinology Adrenal Fatigue Progression Normal stressors/ Repeated stress-high adrenaline Constant Adrenal healthy stress stress-high overload- cortisol collapse Advanced Clinical Focus: Hormones and Endocrinology Adrenal Fatigue Progression Advanced Clinical Focus: Hormones and Endocrinology Adrenal Fatigue Progression Advanced Clinical Focus: Hormones and Endocrinology Stages of Adrenal Fatigue • Follows Hans Selye’s “General Adaption Syndrome” Stage 1 Stage 2 Stage 3 Advanced Clinical Focus: Hormones and Endocrinology Stage 1-Acute Arousal • Rapid increase in adrenaline • Concurrent but slower increase in cortisol • Normalize after event Advanced Clinical Focus: Hormones and Endocrinology Stage 1-Acute Arousal: Triggers • Lack of sleep • Low blood sugar • Heat and cold • Pain • Life threats • Emotional events or thoughts • Drugs Advanced Clinical Focus: Hormones and Endocrinology Adrenal Cascade: “HPA Axis” Stimulus Rest/Digest Fight/Flight/Fright Stop/Think (PNS) (SNS) Stress Hormones Advanced Clinical Focus: Hormones and Endocrinology NUTS • Novel • Unexpected • Threat to the ego • Sense of loss of control Advanced Clinical Focus: Hormones and Endocrinology The only way to make sense of change is to plunge into it, move with it, and join the dance. Alan Watts Advanced Clinical Focus: Hormones and Endocrinology Adrenal Cascade: “HPA Axis” Fear Advanced Clinical Focus: Hormones and Endocrinology Perception is Everything Eustress Distress Advanced Clinical Focus: Hormones and Endocrinology Molecules of Emotion As our feelings change, this mixture of peptides travels throughout your body and your brain. And they’re literally changing the chemistry of every cell in your body. Advanced Clinical Focus: Hormones and Endocrinology Symptoms of ↑ Adrenaline • Insomnia • Awakening with hot flashes/ night sweats • Elevated HR, palpitations • Anxiety • Tremor • Headache • Hot flashes Advanced Clinical Focus: Hormones and Endocrinology Modulators/Dampeners of Adrenaline • GABA • Endorphins • Oxytocin Advanced Clinical Focus: Hormones and Endocrinology Neutraceuticals That Support GABA • Valerian root • Passion flower • L-theanine • Taurine • B6, Mg, Zn, Mn Kharrazian, Datis. Why Isn’t My Brain Working? 2013. Elephant Press. Advanced Clinical Focus: Hormones and Endocrinology Increasing Endorphins • Laughter • Lavender • Sex • Dark chocolate The FASEB Journal. 2006;20:A382 Moss, M., Cook, J., Wesnes, K., & Duckett, P. (2003). Aromas of rosemary and lavender essential oils differentially affect cognition and mood in healthy adults. International Journal of Neuroscience, 113, 15- 38. Advanced Clinical Focus: Hormones and Endocrinology Increasing Oxytocin • Cuddle • Pets • Hug • Sappy movies • Trusting • Interactions on facebook Zak, Paul J. The Moral Molecule: How Trust Works. Penguin Group USA. 2013 Advanced Clinical Focus: Hormones and Endocrinology Stage 2-Adaptation: Triggers • Chronic sleep deprivation (non-adrenal cause) • Emotional and/or physical trauma • Infection • Acute physical stress • Work stress (burnout) Advanced Clinical Focus: Hormones and Endocrinology Stage 2-Adaptation: Triggers • Stress (physical/psych.) • Hx of prenatal/early trauma • Toxins • Infections • Allergens • Poor diet • Sleep deprivation Advanced Clinical Focus: Hormones and Endocrinology Symptoms of Elevated Adrenaline and Cortisol • Irritability/anxiety • Sugar cravings • Fatigue/low energy • Weight gain (middle) • Night sweats • Depression • Muscular tremors • Suppressed immune • Shakiness btwn. meals Advanced Clinical Focus: Hormones and Endocrinology Symptoms of Elevated Cortisol • Memory loss • Depression • Elevated blood sugar/ eventually insulin • Awakening at 2am • Low sex hormones Advanced Clinical Focus: Hormones and Endocrinology Brain Shrinkage and Stress Healthy Sustained Stress Robert M. Sapolsky. Why Zebras Don’t Get Ulcers: Third Edition. 2004 Advanced Clinical Focus: Hormones and Endocrinology “Dinosaur Syndrome” Big body, little brain, become extinct. Dr. Daniel Amen Advanced Clinical Focus: Hormones and Endocrinology Cortisol and Immune • High cortisol may keep an overactive immune system under control • But it may cause depression, hypothyroidism, and memory loss… ↑Cortisol ↓Immune Advanced Clinical Focus: Hormones and Endocrinology Stage 3: Exhaustion • Depressed cortisol • Depressed DHEA Advanced Clinical Focus: Hormones and Endocrinology Symptoms of Depressed Cortisol • Fatigue • ↑ed inflamm. and allergies • Apathy • Depression • Absent-minded • Early menopause • Poor coordination • Muscle pain • ↑ed sleep but ↓ quality Advanced Clinical Focus: Hormones and Endocrinology Reasons for Loss of Adrenal Function • Chemicals and drugs • Infections • Autoimmune • Cancer • Lack of necessary nutrients • Overuse Advanced Clinical Focus: Hormones and Endocrinology Areas of Variability • Perception • Second messenger system • Genetics • Production of • Prenatal programming hormones • History (i.e. trauma) • Interaction of hormones • Receptors • Metabolism of hormones Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Stage I: Stressed and wired • Stage II: Stressed and tired • Stage III: Stressed and depleted Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Follow 4-point cortisol measure • Saliva Low Normal Optimal Normal High 50 37.5 25 12.5 0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Trouble with sleep • “Wired and Tired” Low Normal Optimal Normal High 50 37.5 25 12.5 0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Insomnia • Early morning waking Low Normal Optimal Normal High 50 37.5 25 12.5 0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Anxious during the day • Poor blood sugar control • Stressful job Low Normal Optimal Normal High 50 37.5 25 12.5 0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Tired/groggy in the morning • Difficulty waking and starting the day Low Normal Optimal Normal High 50 37.5 25 12.5 0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Patterns of Adrenal Dysfunction • Tired always • Poor blood sugar control Low Normal Optimal Normal High 50 37.5 25 12.5 0 Morning Noon Evening Night Advanced Clinical Focus: Hormones and Endocrinology Testing Adrenals: Iris • Iris contraction test: • Shine light into eye • Look for inability to maintain contraction • Normal = pupil remains contracted
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