• Dr. Trish Pearce

2. What is adrenal fatigue?


Adrenal fatigue, burnout, exhaustion, dysfunction…all are commonly used terms to refer to “adrenal maladaptation syndrome,” a way of classifying the level of adrenal function developed by endocrinologist Dr. Hans Selye, in 1936. The overall functioning of the HPA axis can be classified into three categories: I. Alarm II. Resistance III. Exhaustion

Interestingly, only the last stage is technically termed adrenal exhaustion, or fatigue. Since each category is reflective of the overall health and ability of the adrenal glands to respond to stress, it is very important to understand that each stage warrants its own unique approach in terms of support and management.

During the “alarm stage,” the adrenal glands respond normally to the various and sundry stressors of life by reflexively increasing output of the hormone cortisol, which raises blood sugar, and epinephrine/norepinephrine (adrenaline), which are responsible for the “fight or flight” response. Once the stress response is over, cortisol and adrenaline should go back to normal levels in the body within a few hours.

The “resistance stage” is so named because rather than properly responding to the occasional stressor, the body is being exposed repeatedly and continuously to the same low to moderate level stressors. In this stage, the adrenal glands are called upon so frequently to produce cortisol that the normal daily “cortisol rhythm” begins to degrade, leading to low energy during the day and insomnia at night. The resistance stage is characterized by reduced tolerance to stress.

“Exhaustion,” or true “adrenal fatigue” occurs when the body has been responding to repeated stressors for so long, cortisol must be produced in higher and higher amounts in order to get the same response from the body. Ultimately, this process exhausts the HPA axis entirely, and cortisol levels plummet well below normal. Symptoms commonly associated are debilitating fatigue, widespread pain, obesity, and weakness.

Identifying your stage of adrenal maladaptation is essential for choosing the correct lifestyle and supplemental interventions. Finding and addressing triggers for adrenal dysfunction is paramount in preventing long term consequences to health-see article #3 in the series: “Common Triggers for Adrenal Dysfunction.”


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