“Oh, It’s Just Stress!” – Is It Really? What You Should Know About Hypoadrenalism
Have you ever mentioned a health issue to your doctor, or a friend or relative, only to be told that it’s probably just related to stress? Perhaps they’ve even suggested that your health problem would most likely go away if you simply reduced the amount of stress in your life?
Many of us have heard this at one time or another and, for some, that “diagnosis” may be correct. For others, there may be more to the story.
In any case, before jumping to conclusions or dismissing their well-intentioned advice, you may want to make sure that your body’s mechanisms for dealing with stress are in good working order. That means ruling out an adrenal gland insufficiency known as hypoadrenalism.
You may remember from biology class that the adrenal glands prepare the body for action when presented with a “fight or flight” situation. Although it’s easy to see how important those reactions were for cavemen and people who lived during more strenuous times, you may think that we don’t rely on them much anymore.
Yet today, perhaps more than ever, our bodies (and minds) are constantly bombarded with stressful situations that trigger adrenal activity. But what happens to our adrenal glands if we do not allow them to recover? They can become overworked, sometimes to the point of exhaustion, and hypoadrenalism may result.
When it does, we may become debilitated by chronic fatigue and a variety of other troubling symptoms, such that we are ill-equipped to deal with life’s daily stresses.
About the Adrenal Glands
In addition to helping us deal with life’s stresses, the adrenal glands are essential for the body’s ability to adapt to changes in our environment, such as temperature fluctuations, food and water, and the amount of rest we get.
The adrenal glands are located at the upper end of each kidney, as shown in the figure below. They are composed of two parts, which are known as the medulla and the cortex. The medulla, or inner portion of the adrenal gland, produces epinephrine (formerly called adrenalin) and norepinephrine. These hormones are triggered in response to acute stresses, such as fear and anger. They are responsible for increasing your heart rate and blood pressure, and mobilizing sugar from your liver into your bloodstream.
The cortex, or outer surrounding layer, produces over 40 different hormones called corticosteroids, which are essential for responding to more prolonged stresses, such as physical exertion or strenuous exercise, injury, illness, infection, or worry. Hydrocortisone (also known as cortisol) is thought to be the most important corticosteroid. Cortisone, which is also produced by the adrenal gland but in smaller quantities, is converted to hydrocortisone by the body.
Hydrocortisone’s primary function is to stimulate the conversion of protein to glucose, which is vital to maintaining appropriate levels of blood glucose for brain function and use of the muscles and tissue, especially between meals or snacks.
Other steroids produced by the cortex affect muscle and tissue growth and development, and regulate our fluid and electrolyte balance. The adrenal glands also produce small amounts of estrogen, testosterone and progesterone.
Being part of the endocrine system, the adrenal glands work in conjunction with the thyroid, pituitary, and hypothalamus glands. If any one of these glands begins to malfunction, the effects often ripple through other endocrine glands (and eventually the whole body), making it difficult to tell which one is actually the true source of the problem.
Dr. Robert Atkins promoted a simple blood pressure test (below) for determining if your adrenal function is adequate.
Hypoadrenalism was first described by Sir Thomas Addison in 1855, so it is sometimes called Addison’s disease. The reverse condition, an over-productive adrenal gland, is called Cushing’s disease or hyperadrenalism. Of the two, hypoadrenalism is much more common. Some people are born with low adrenal function (sometimes called congenital hypoadrenalism), especially if their mother was hypoadrenal during pregnancy. In others, it may manifest over time as the adrenal gland becomes increasingly inadequate in responding to stress (known as acquired hypoadrenalism). In either case, this condition can stem from a problem with the adrenal gland itself (primary hypoadrenalism), or result from a related dysfunction, such as a problem with the hypothalamus or pituitary gland, or from a hormone imbalance (secondary hypoadrenalism). Secondary acquired hypoadrenalism, which typically involves a malfunction of one or more of the pituitary/thyroid/adrenal aspects of the endocrine system, seems to be the most common form.
Symptoms of Hypoadrenalism
In any case, the symptoms of hypoadrenalism can range from extreme to mild conditions. It is not typically an “all or nothing” disease, resulting instead in a sometimes perplexing variety of symptoms that are similar (and perhaps related) to those of a number of other conditions, including hypoglycemia (see below) and hypothyroidism. In fact, people with adrenal insufficiencies tend to have a low basal metabolism, similar to people with hypothyroidism.
There is also some speculation that adrenal function effects personality type. Dr. John Tintera, one of the pioneers of research on adrenocortical dysfunction, observed certain personality traits in patients with adrenal insufficiency. In one published report, he states that they are “usually very meticulous in their work. They are perfectionists who often drive themselves to exhaustion since they do not know the meaning of the word relaxation.”
While it may seem more prevalent today, hypoadrenalism is not necessarily the result of our modern lifestyles. Back in the 1920s, Dr. Louis Berman reported on the symptoms associated with “a general disturbance of the body and mind,” which is now thought to be hypoadrenalism. According to Dr. Berman, the patient “cannot sleep when he lies down, he cannot keep awake when he stands up. He cannot concentrate, but still he is pitifully worried about his life. The slightest irritation causes him to go off the handle. As he works himself up into his hysterical state … irregular blotches may appear on his face and neck. Generally, his hands and feet are clammy and perspiring, his face is abnormally flushed or pallid … As the blood pressure is too low for his age, the circulation is nearly always inadequate and palpitations of the heart is a frequent complaint. … The brooding over themselves and their troubles is one of the distinctive features of the whole complex.”As Dr. Berman noted, many people with an adrenal insufficiency report being overexcited when they should rest and sleep, and tired and weak when they need to function. Not surprisingly, the primary symptom of hypoadrenalism is excessive fatigue (some people may think they have chronic fatigue syndrome). This fatigue is often accompanied by a variety of other symptoms, including:
- Weakness or light-headedness
- Sensitivity to cold
- Cold hands and feet, which may also be a mottled bluish-mottled color
- Loss of appetite
- Cravings for salt or sweets
- Alcohol intolerance
- Excessive worrying
- Darkening of the skin
- Dry skin
- Light or no perspiration
- Sparse hair
- Slouching posture.
As mentioned earlier, the adrenal glands also produce some estrogen, progesterone and a little testosterone.
According to Dr. Jefferies, “Adrenal estrogen seems to be mainly involved in providing a supply of this hormone during menses and at the menopause when production by the ovaries is temporarily or permanently interrupted, but it may have other, as yet unrecognized functions in growth or development.” Because of this, women with hypoadrenalism can also experience symptoms such as:
- Premenstrual syndrome (PMS)
- Menstrual irregularities
- Ovarian dysfunction
Men with hypoadrenalism may also have:
- Low sperm count
- Enlarged breasts.
Many of the symptoms mentioned surface during or after a physical, mental, or emotional stress, when adrenal reserves are especially low. For example, in his book Safe Uses of Cortisol, Dr. Jefferies discusses “jet lag” (sidebar on right) as perhaps being related to a temporary adrenal insufficiency, which is not surprising given the many physical and emotional stresses associated with traveling.
Dr. Jefferies also suggests that “In many cases adrenal insufficiency seems to result from a type of autoimmune phenomenon.” People often describe their symptoms as “flu-like” with acute malaise, generalized muscle aches, weakness, loss of appetite, and fever. (In fact, when you have the flu your levels of hydrocortisone are diminished due to your body’s attempts to fight off the virus.) Dr. Jefferies and others have observed that this type of hypoadrenalism seems to be related to an impaired hypothalamic or pituitary response (i.e., secondary), rather than stemming directly from the adrenal gland.
Allergic disorders, which are also related to our immune response, can also be associated with hypoadrenalism. Evidence suggests that a deficiency of hydrocortisone may contribute to an excess of histamine, which can lead to allergic rhinitis (runny nose), allergic asthma, and itching.
It is a well-known fact that many rheumatoid arthritis patients respond favorably to cortisone-based treatments, which suggests there may be a corollary with hypoadrenalism. However, there is some speculation that arthritis may result from an underlying malfunction of steroid metabolism, also possibly related to autoimmune factors.
Dr. John Tintera observed that hypoadrenalism and hypoglycemia are often associated. The strong relationship between the two is not surprising, since adrenal production of hydrocortisone is necessary for the conversion of protein to glucose.However, it is interesting that, in both conditions, the onset of symptoms is not identified as much with a specific level of a substance as it is with a sudden drop in that substance. In hypoglycemia, it is blood sugar or glucose; in hypoadrenalism, it is hydrocortisone.
The relationship between hydrocortisone levels and the aging process is currently a hot topic among healthcare practitioners. Dr. Thierry Hertoghe reports an increase in age-related disease among patients with adrenal insufficiency, and suggests that low hydrocortisone levels are one reason why elderly people tend to worry so much. He also points out that high hydrocortisone levels may block memory, leading to symptoms associated with dementia.
Treatment of Hypoadrenalism
Most often, the symptoms of hypoadrenalism are the result of a hydrocortisone deficiency. As such, appropriate natural hydrocortisone replacement therapy typically eliminates most (if not all) of the symptoms of adrenal insufficiency, sometimes producing astounding results. Many patients report feeling much, much better within 24 hours of treatment.
In the past, there has been some confusion about the benefits of cortisone and hydrocortisone treatments. This confusion primarily stemmed from the fact that the earliest treatments relied on doses that were much higher than those normally produced in the body, which produced some undesirable and potentially hazardous side effects. Over the years, many healthcare practitioners have assumed that any dosage potentially produces the same results (which evidence indicates is not true).
In addition, many people confuse cortisone and hydrocortisone with their more potent derivatives (such as prednisone and dexamethasone), which may produce
undesirable side effects with prolonged use. As such, these people tend to assume that all “cortisone therapy” can be harmful (again, the evidence indicates that this is not true).
After years of successfully treating patients with smaller doses that more closely resemble those that the body naturally produces, Dr. Jefferies and others now promote the use of hydrocortisone as a safe and effective treatment for hypoadrenalism. For most people, the typical treatment option would be a medication called cortisone acetate or hydrocortisone (Cortone® and Cortef® respectively, and their generic equivalents). Compounded medications are also available.
Dr. Jefferies recommends dosing these replacement medications four times per day to maintain the body’s normal levels. Some people may also experience symptom relief using naturopathic remedies, such as licorice root (above).
Evidence suggests that prolonged administration of low dosages (i.e., within or lower than the replacement level) of cortisone acetate or hydrocortisone does not impair adrenal response. In Dr. Robert Atkins’ Health Revelations newsletter, Dr. Atkins reported on the current revolution in hydrocortisone research. Dr. Atkins emphasized the importance of maintaining a healthy hydrocortisone level to minimize the effects of stress and aging. In addition to working with your doctor to determine if your adrenal glands are functioning properly, he suggested the following course of action:
- Simplify your life. Use relaxation techniques and hobbies to help you deal with the stresses you can’t avoid.
- Reduce the amount of carbohydrates in your diet, because refined starches and sugars can interfere with adrenal gland function.
- Exercise moderately. Low-intensity exercise helps you to deal with stress, and is a natural way to control hydrocortisone levels.
- The Glands Regulating Personality by Louis Berman, MD, The Macmillan Company, New York, NY, 1921.
- Safe Uses of Cortisol by William McK. Jefferies, MD, FACP, Charles C. Thomas Publisher, Springfield, IL, 1996.
- “The Hypoadrenocortical State and Its Management” by John W. Tintera, MD, in New York State J. Medicine, July 1, 1955.
- “Licorice Root for Inflammation” by Ellen Kamhi, RN, PhD, and Eugene Zampieron, ND, AHG, in the International Journal of Integrative Medicine, Vol. 2, No. 5, September/October 2000.
- Dr. Thierry Hertoghe, recorded at the American Academy of Anti-Aging Medicine, Las Vegas, NV, December 1999.
- Dr. Robert Atkins’ Health Revelations newsletter, Volume VIII, Number 2, February 2000.