Diagnosing Adrenal Dysfunction

Beta Switch Program

The Beta Switch Program by Sue Heintze

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The fine homeostatic balance between health and disease can be disturbed if the clinical cause of a patient's original imbalance is not fully explored and treated. Indeed, replacement or augmentation of hormones from exogenous sources, all too often, merely suppresses symptoms while leaving the underlying disease process to advance without the diagnostically helpful symptoms. When addressing adrenal imbalance, it is essential to look beyond laboratory tests and symptoms alone and to integrate the clinical presentation as a whole. Just as overt signs and symptoms of thyroid dysfunction may or may not always manifest with abnormal laboratory tests, a functional adrenal condition may be present in the absence of abnormal laboratory findings. In fact, a recent plethora of medical literature points to the seemingly error-prone assessment that results from measuring thyroid function solely via laboratory tests. The main cause of adrenal fatigue is continual low-level stress, which taxes the adrenal glands, limiting their ability to adapt to acute stressors. This low-level stress may be caused by emotional or physical upsets or loss of sleep. Clinically, this manifests in the development of exhaustion that does not become resolved with standard rest and relaxation.

A large number of symptoms associated with adrenal dysfunction have been reported in the literature. These symptoms are often categorized according to physiologic performance, psychologic=information processing, and immunologic and biochemical parameters.70 To date, however, there is no universally agreed-on group of symptoms that describes accurately the condition or the physiologic=psychologic=emotional distresses that some people experience. Rather, multiplesymptoms may present in no particular combination under the general categories of adrenal exhaustion, hypoadrenocorticalism, and hyperadrenocorticalism. Perhaps the most confusing and controversial clinical component of diagnosing and treating adrenal imbalance is codifying the testing parameters to determine conclusively the presence of adrenal exhaustion and dysfunction. To advance alternative medicine in evidence-based clinical practice, tools must be developed that can give practitionersacomprehensiveapproach to diagnosing adrenal burnout syndrome. By combining biochemical studies, endocrine assays, and physiologic functioning tests, these assessment methods would allow a clinician to gain a greater understanding of a patient's stress response. Numerous assessment methods have been proposed and are utilized to measure and track adrenal dysfunction. Some of these testing models are listed below.

The 24-Hour Salivary Cortisol Pattern

This pattern consists of four points—7 am-8 am, noon, 4 pm-5 pm, and 11 pm-midnight. Research suggests that measuring salivary, as opposed to serum, cortisol and DHEA levels may be the best indication of adrenal function.71-74 Yet controversy exists concerning the complete validity of such testing methods because of potentially confounding variables, such as dietary interference, diurnal variations in salivary production and viscosity, oral contaminants, and the potential presence of gingival disease or problems regarding the mouth ecology. A 24-hour urine test may provide a better overall picture of glandular function in contrast to a spot urine or blood test, which provides merely a ''snapshot'' of physiological functioning. In addition, the

To compensate for increased stressors, many individuals have turned to ergogenic or energy enhancement substances.

24-hour urine measures free cortisone to cortisol ratio, which is useful to identify issues related to 11-beta-hydroxysteroid dehydrogenase, the enzyme that converts active cortisol to inactive cortisone.

The 24-Hour Urine Free-Hormone Profiles

ACTH is part of a complex pathway of biochemical messengers. It is, therefore, difficult to identify where, exactly, in this ''pathway'' dysfunction may be occurring. In response to this complexity, comprehensive testing laboratories have developed methods for evaluating primary and secondary steroid hormones and their most important metabolites. This provides practitioners with a tool to examine the stress response more fully in the context of overall hormonal balance including precursors and metabolites of the hormones.75

sIgA

A protein modulator of immune activity, sIgA is intimately linked to the activity of the autonomic nervous system. Alterations and dysfunctions in the autonomic nervous system can be measured directly by changes in salivary composition and excretion. Medical researchers have recently theorized that factors such as exercise and chronic stress might induce changes in several components of saliva, such as immunoglobulins and proteins. Acute stress increases sIgA secretion immediately after the stressor, while the chronic stress causes a decrease in sIgA secretion several days after the stressor.

Plasma Glutamine

Glutamine is considered to be a conditionally essential amino acid because it can be synthesized in the body from glutamic acid. Glutamine is an important modulator of many homeo-static functions and optimal functioning of specialized tissues within the body. These tissues are key to gut and immune system function. Researchers have recognized certain conditions in which the body's demand for glutamine exceeds its ability to synthesize it. Such conditions are associated with high levels of physiologic stress. Under such chronic, catabolic conditions, the body takes its supply of glutamine from muscle tissue.76 Glutamine may be decreased after surgery and other stressors.

Total Blood Cholesterol

Researchers theorize that because the body alters its ability to compensate for a shift in adrenal function, stress has a deleterious influence on cholesterol synthesis and specific lipoprotein molecules. Measuring total body cholesterol will allow researchers to correlate changes in adrenal function with shifts in cholesterol levels. Chronic stress is associated with high LDL-cholesterol and low HDL-cholesterol.

Serum Ferritin

Ferritin reflects the body's iron stores and is a good indicator of iron storage status. The ferritin test is more sensitive than the iron or total iron binding capacity test for diagnosing iron deficiency or overload. Measuring ferritin levels will provide an additional means of assessing immune function and physiologic adaptation to stress. Serum ferritin concentrations can be significantly depressed under physical stress.

Morning Basal Body Temperature

Cortisol has a profound suppressive effect on thyroid-axis function. In the presence of elevated cortisol, thyroid functioning can become significantly impaired. The resultant changes in thyroid metabolism can include suppression of thyroid-stimulating hormone (thyrotropin; TSH) and decreased conversion of thyroid hormone from thyroxine (T4) to the more potent form of triiodothyronine (T3) in peripheral tissues. It has been hypothesized that these effects arise from inhibition of the enzyme 5-deiodinase, affecting the T4 to T3 conversion and suppression of TSH by endogenous somatostatin. Increased cortisol can cause peripheral tissues to no longer respond to the thyroid hormone signal. It creates a condition of thyroid resistance, meaning that thyroid hormone levels can be normal, but tissues fail to respond efficiently to the thyroid signal, causing symptoms of hypothyroidism such as low basal body temperature.

Postural Muscle Assessment

Research has identified restricted muscular sodium=potassium adenosine triphosphatase (ATPase) activity and reduced cortisol levels in chronically stressed rats. Studies suggest that it is necessary to have an "intact pituitary-adrenal axis for adequate function of the sodium= potassium pump.''77,78 An ion shift with an increased extracellular potassium concentration has also been proposed as a possible cause of muscular complaints during exercise in patients who use beta-blockers. Postural muscles (gastrocnemius, soleus, medial hamstrings, short adductors of the thigh, hamstrings, psoas, piriformis, tensor fascia lata, quadratus lumborum, erector spinae, latissimus dorsi, upper trapezius, sternomastoid, levator scapulae, pectoralis major, and the flexors of the forearm) shorten under stress. Therefore, evaluation of the postural muscles may be applicable to stress-induced health conditions.

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