At the center of the stress response are the adrenal glands. The adrenals produce epinephrine and norepinephrine, along with other hormones such as cortisol that enable the body to adapt to and survive a stressor. The acute alarm, or immediate reaction to a stressor, is a physiologic phenomenon in which the sympathetic nervous system responds to exogenous or endogenous stressors that put the body into what is popularly called the "fight, fright, or flight'' mode. When the body is in this state, such as in potentially life-threatening situations, adrenal hormones are released to increase heart rate and blood pressure and divert blood to the brain, heart, and skeletal muscles. This physiologic compensation is a key mechanism in stress and the clinical phenomenon of adrenal fatigue. The adrenal cortex produces steroid hormones, which include cortisol, corticosterone, testosterone, estrogen, 17-hydroxyketosteroids, dehydroepiandroster-one (DHEA), DHEA sulfate, pregnenolone, aldosterone, androstenedione, progesterone, and other intermediates to hormone production. These are the most widely studied of the stress-related hormones. Although most of these hormones are created in different parts of the body, aldosterone, cortisone, and hydrocortisone are produced only in the adrenal glands. Aldosterone, working in cooperation with the renal system, helps to regulate the balance of sodium and potassium in the body. This regulation is critical to many physiologic functions, including the ability to react to stress and to maintain fluid balance. This hormone also contributes to the maintenance of blood pressure. In "adrenal fatigue'' states, patients may have alterations in the fluid-balancing mechanism, with the most commonly described symptom being "puffy hands and feet.'' Recent conventional medical research has shown that subclinical adrenocortical disease can exist without adrenal function failure.4 The etiology of this subclinical disease process has not been elucidated fully in conservative research. Authors who write for alternative medical periodicals and texts have historically expressed a belief that severe, long-term stress can lead to a clinical phenomenon known as "adrenal burnout.''5,6 Most individuals adapt to the stresses of life and, when these stressors are reduced, these patients experience favorable psychophysiologic responses, demonstrating the correlation between stress and physiologic functioning.7 Being unable to adapt to stressors can manifest as "staleness syndrome'' or adrenal dysfunction.5,6,8 Individuals who experience this disorder are unable to perform at their customary levels of activity at the office or home. They seem to suffer from persistent deterioration in their everyday functioning and activities. Indeed, depression and a marked decrease in performance seem to be the hallmark of this maladaptation syndrome.9,10
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