Adrenal Stress Index/Interpretation Flashcards
the adrenal glands produce complementary hormones ___ and ___
DHEA and cortisol
____ mobilizes protein stores in all tissues except the ____ and mobilizes fatty acids from adipose tissue
cortisol
liver
the general effect of excess cortisol is usually ____
catabolic (breaking things down)
DHEA is the major precursor of what
testosterone
Estrogens
what is the most active form of DHEA and which is measured
DHEA-S
average of two DHEA-S 12-1 and 4-5pm
what is the normal DHEA-S level and the ideal
normal: 2.0-10.0ng/ml
ideal: 7-8ng/ml
what serves as an early sign of adrenal exhaustion
decreased DHEA levels
sIgA and cortisol/DHEA
abnormal cortisol/DHEA increased or decreased causes a decreased activity in the immunocytes that produce sIgA.
what is the primary hormone that directs immune function
cortisol
names for chronic stress response
pregnenolone steal
cortisol escape
elevated cortisol to DHEA ratio
what is the idea cortisol to DHEA ratio
5:1 - 6:1
what is pregnenolone steal and outcomes
under periods of stress, the body diverts pregnenolone preferentially to (progesterone and then) cortisol. At the detriment of all other hormones: progesterone, aldosterone, estrogen, testosterone. DHEA depletion sets in.
result: high Cortisol:DHEA ratio.
benefits of saliva testing with hormones
it analyses the biologically active compounds that are active at the cellular level.
downside to blood cortisol level testing
blood serum cortisol is mostly protein bound which means about 1-10% of the steroids in the blood are unbound and free. The rest is bound and is biologically unavailable.
Stage 1 Adrenal Exhaustion as seen on lab
an initial increase in cortisol output
-at least one cortisol is high
-total cortisol sum is high
-DHEA borderline low, low or normal
an initial increase in cortisol output
-at least one cortisol is high
-total cortisol sum is high
-DHEA borderline low, low or normal
Stage 1 Adrenal Exhaustion
distinguishing features of Stage 1 Adrenal exhaustion
INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation
-cortisol output
-probability of pregnenolone steal
-probability of decreased DHEA
INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation
-cortisol output
-probability of pregnenolone steal
-probability of decreased DHEA
Stage 1 Adrenal exhaustion
State 1 Adrenal Fatigue defined
prolonged increased excitatory stimulus to the adrenals having resulted in a prolonged, increased cortisol output, usually with a decrease in DHEA.
prolonged increased excitatory stimulus to the adrenals having resulted in a prolonged, increased cortisol output, usually with a decrease in DHEA.
Stage 1 Adrenal Exhaustion
where is ACTH released
pituitary gland
what does increased ACTH released from the pituitary gland lead to
stimulation of the adrenal glands
ACTH stimulates the adrenals to release cortisol under periods of stress. continued demand for increased cortisol necessitates ongoing ACTH released by the pituitary but the adrenals eventually have a hard time keeping up and leads to this
state 1 adrenal exhaustion
the overall cortisol increase in stage 1 adrenal exhaustion is due to a combination of
increased cortisol output by the adrenals and pregnenolone steal
how to calculate the adrenal adaptation and zone placement
sum of the total noon and afternoon cortisol and divide by 2. then plut verse the DHEAS.
patients with what might you see their zone of cortisol/dhea in “C”
addisions disease
they are unable to produce stress hormones
stage 2 adrenal exhaustion as seen on lab
AM, Noon or afternoon cortisols are low or borderline low
total cortisol sum is normal
DHEA is borderline low or low
distinguishing features of Stage 2 Adrenal exhaustion
INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation
-normal total cortisol output
-normal nighttime cortisol level
-low or borderline-low morning, noon or afternoon cortisol levels
-probability of pregnenolone steal
-probability of decreased DHEA
INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation
-normal total cortisol output
-normal nighttime cortisol level
-low or borderline-low morning, noon or afternoon cortisol levels
-probability of pregnenolone steal
-probability of decreased DHEA
Stage 2 Adrenal exhaustion
this phase can be confusing and appear to be a normal cortisol phase, but don’t be fooled it signifies a continuing decline in cortisol output from levels above normal to those below, although ACTH stimulation remains high or even increases.
phase 2 adrenal exhaustion
stage 3 adrenal exhaustion as seen on lab
most cortisols are low or borderline low
total cortisol is low
DHEA is boarderline low or low
stage 3 adrenal exhaustion distinguishing features
-increased anterior pituitary output of ACTH
-increased adrenocortical stimulation
-decreased total cortisol output
-increased pobability of decreased nighttime cortisol level
-probability of pregnenolone steal
-probability of decreased DHEA
most cortisols are low or borderline low
total cortisol is low
DHEA is boarderline low or low
stage 3 adrenal exhaustion
-increased anterior pituitary output of ACTH
-increased adrenocortical stimulation
-decreased total cortisol output
-increased pobability of decreased nighttime cortisol level
-probability of pregnenolone steal
-probability of decreased DHEA
stage 3 adrenal exhaustion
marked by the failure of the adrenals to produce enough cortisol to reach even normal levels in response to continues increased ACTH stimulation
stage 3 adrenal exhaustion
endocrine and autonomic pathways through stress have been conditioned by a complex of stimuli to respond beyond normal physiological ranges. this conditioning ultimately results in adrenal glad inability to produce the amount of cortisol demanded by the dress of stimulation
stage 3 adrenal exhaustion
decreased nighttime cortisol is a marker of what stage of adrenal exhaustion
3
what is a hallmark of stage 3 adrenal exhaustion
decreased nighttime cortisol
low DHEA is a normal finding in whom
children under 14 years old
licorice will not be effective in cortisl augmentation when morning cortisol is X< ?
less than 5 nM
may be necessary to add 15mgs of hydrocortisone
pregnenolone augmentation is necessary when the cortisol burden is what
X<23 or x>85
(less than 23 or more than 85)
when is cortisol contraindicated
in diabetic or pre-diabetic patients
High cortisol:DHEA ratio restoration
-pregnenolone
-DHEA
-support adrenals
-seriphos
low cortisol:dhea ratio
-licorice extract
-support adrenals
-may need prescription cortisol
-lifestyle changes
this is recommendation for what
-pregnenolone
-DHEA
-support adrenals
-seriphos
High cortisol:DHEA ratio restoration
this is recommendation for what
-licorice extract
-support adrenals
-may need prescription cortisol
-lifestyle change
low cortisol:dhea ratio
elevated 8am cortisol levels are suggestive of what
hyperstimulated adrenal gland engaged in glucose counter-regulation. Nocturnal hypoglycemia
depressed 8am cortisol is suggestive of
adrenal hypofunction
elevated noon and 4pm cortisol levels are suggestive of
tendency toward hypoglycemia
depressed 4pm cortisol levels are suggestive of
hypofunctional gland with poor glucose counter-regulation and an afternoon performance slump
elevated 11-12 (midnight) cortisol are indicative of
hypothalamic-pituitary hyperactivity
insensitivity to negative feedback
endogenous biological depression
