HPA Axis Dysfunction is a Legitimate — and Accurate Medical Diagnosis

I recently read an article on adrenal fatigue posted on a leading medical organization’s website that began with the claim that, “Adrenal fatigue isn’t an acceptable medical diagnosis.” This same article ended by stating, “. . . accepting a medically unrecognized diagnosis from an unqualified practitioner may leave the real cause — such as depression or fibromyalgia — undiagnosed, while it continues to take its toll.”

To be fair, the author is an M.D. and Ph.D. who studies the relationship between osteoporosis and cardiovascular disease and the potential role of estrogen in the development of both diseases. And the conventional medical community also recognizes adrenal insufficiency as a medically recognized diagnosis.

But to imply that adrenal fatigue is any less legitimate a diagnosis, or that the illness is any less “medical” in nature is puzzling. Especially when the same author recognizes depression and fibromyalgia as actual medical diagnoses. Truth is, even the medical community has no lab test for either of them.

In fact, I would suggest the opposite; that depression and fibromyalgia are not acceptable medical diagnoses and that accepting either diagnosis without a much deeper examination often leaves the real cause — an underlying adrenal-related physical condition undiagnosed and untreated.

I often see patients who have been diagnosed with depression or fibromyalgia or chronic fatigue syndrome — all medically-recognized diagnoses — who continue to suffer even when receiving what the conventional medical community deems proper treatment. Many of these patients have been diagnosed based solely on a process of elimination. It’s almost as if the doctor had given up resolving the issue and reached for a prescription pad in frustration.

Adrenal-related illnesses, like many medical ailments, exist on a spectrum and often involve more than one gland or organ or system. They are complicated conditions that require careful examination and detailed testing to unravel the mystery, and they often address several interrelated dysfunctions. Adrenal illnesses cannot be treated effectively simply by taking medications that suppress symptoms or supplements promoted solely for supporting immune function.

In this post, I describe a variety of health conditions related to the adrenal gland, some that may be caused by dysfunction upstream of the adrenal. With a greater understanding of the adrenal gland and dysfunctions that impact its health and function, my hope is that anyone with symptoms of an adrenal disorder seek a medical diagnosis from a functional and integrative medical practice to get at the root of what’s going on.

Adrenal fatigue

It was back in 1998 that James L. Wilson, DC, ND, PhD of Tucson, Ariz., coined the term “adrenal fatigue” and used it to describe a condition in which the adrenal glands — overstimulated by chronic stress — burn out and shut down, causing a variety of symptoms, including:

• Abdominal pain
• Chronic fatigue
• Depression
• Diarrhea
• Excessive sweating
• Headache
• Hypoglycemia (low blood sugar)
• Irregular periods in women
• Irritability
• Loss of appetite
• Low blood pressure
• Muscle weakness
• Nausea
• Salt cravings
• Weight loss

In the 22 years since, many books have been published and an untold number of nutritional supplements have been developed to support the adrenal gland. Unfortunately, — and not surprising — far too many people who follow the advice in these books or take these supplements, have no idea what is really occurring in their bodies. As a result, the root cause of their symptoms remains untreated, and they may even be doing more harm than good. (For more information on Adrenal Fatigue, read BioDesign Wellness’ post Feeling Burned Out? You May Be Suffering from Adrenal Fatigue.)

Adrenal disorders

As you may expect from what I shared at the beginning of this post, conventional medicine continues to deny the existence of adrenal fatigue, but recognizes several adrenal disorders, including:

• Adrenal cancer, which is characterized by weight loss, abdominal pain, or overproduction of certain hormones, such as androgens and cortisol, which can also cause high blood glucose and high blood pressure, and (in women) irregular periods and increased hair.
• Adrenal incidentaloma, which is caused by tumors or masses larger than one centimeter on the adrenal gland itself, which may lead to an overproduction of hormones.
• Adrenal insufficiency (Addison’s disease), which is a condition whereby the adrenal glands do not produce sufficient amounts of certain hormones, causing many of the symptoms commonly attributed to adrenal fatigue. Adrenal insufficiency is commonly broken down into two classes:
• Primary: Caused by damage to the adrenal gland as a result of an autoimmune condition in which the immune system attacks the adrenal glands, tuberculosis or other infections, cancer, or internal bleeding into the adrenal glands.
• Secondary: Due to the pituitary gland not producing enough adrenocorticotropic hormone (ACTH) to stimulate hormone production in the adrenal gland.
• Cushing’s disease, which is a condition whereby the adrenal glands produce too much cortisol, often resulting in weight gain and fat distribution mostly in the abdominal region, easy bruising, poor wound healing, thinning of the skin, muscle weakness, irritability, weak bones, fatigue, high blood pressure, high blood sugar, anxiety, depression, mood swings, acne, increased thirst and urination, and (in women) irregular periods and growth of facial hair.
• Pheochromocytoma, which causes tumors inside the adrenal gland. Such tumors can lead to an overproduction of epinephrine and norepinephrine, typically resulting in high blood pressure.
• Conn’s syndrome (primary hyperaldosteronism), which is overproduction of aldosterone by the adrenal glands, and that can result in high blood pressure, excessive thirst and urination, headaches, and muscle weakness or cramps.

HPA axis dysfunction

The diagnosis now being used in place of “adrenal fatigue” and “adrenal insufficiency” is called hypothalamus, pituitary, adrenal (HPA) axis dysfunction. This diagnosis is more accurate than that of adrenal fatigue and adrenal insufficiency, because it recognizes that the adrenal gland does not function in a vacuum — problems upstream of the adrenal gland can and often do impact adrenal function. “HPA” refers to the three components involved in adrenal hormone production:

• Hypothalamus: The region of the brain that enables the body to maintain homeostasis (equilibrium) by regulating sleep, emotions, body temperature, hunger, thirst, and so on.
• Pituitary gland: A pea-sized gland at the base of the brain that regulates other endocrine glands, including the adrenal.
• Adrenal glands: Small glands, one atop each kidney, that produce certain key hormones, including cortisol, aldosterone, DHEA, androgenic steroids, epinephrine (adrenaline), and norepinephrine (noradrenaline).

Working together, these three components regulate energy levels, stress response, metabolism, mood, motivation, and immune system. Here’s how it works:

1. In response to stress, the hypothalamus secretes corticotropin-releasing hormone (CRH) to signal the pituitary gland.
2. In response to the CRH, the pituitary releases ACTH to signal the adrenal glands.
3. In response to the ACTH, the adrenal gland secretes glucocorticoids, including cortisol.

HPA axis dysfunction results when one or more of the three components of the HPA axis is not doing what it should be doing. For example, if the hypothalamus fails to signal the pituitary gland to release ACTH, then the adrenal gland won’t produce sufficient amounts of cortisol. The problem then, is not with the adrenal gland but with the hypothalamus.

What is really going on?

People who suffer from HPA axis dysfunction are often undiagnosed or misdiagnosed and end up “chasing symptoms.” For example, they may be taking antacids to treat indigestion or getting steroid shots to reduce inflammation caused by low cortisol. The root cause of their symptoms is never addressed, and the treatments they are receiving often do more harm than good.

Usually the root cause of HPA axis dysfunction is inflammation due to a variety of stressors, including emotional stress (at home or work), undiagnosed infections, exposure to environmental toxins (such as toxic mold) and pollutants, and food sensitivities or poor diet. Inflammation will cause dysregulation of the signals in the brain coming from the hypothalamus, causing a chain reaction that impacts the pituitary gland and ultimately the adrenal glands. This will have a “whole body” effect with numerous symptoms that are difficult to trace to any single illness or dysfunction.

Effective treatment typically involves identifying and reducing the impact of stressors, treating any underlying infections, reducing exposure to environmental toxins, detoxing the body, and adjusting the diet to eliminate any problem foods. Restoring health to the gut may also be necessary. And, yes, even the digestive system, which may seem totally unrelated to the adrenal gland, can impact its health and function.

However, the first step is to obtain an accurate diagnosis from a doctor who understands the HPA axis dysfunction. If you or a loved one is experiencing any of the symptoms described in this post, I strongly recommend that you schedule an appointment with me for an examination and testing. If you are not living in the Tampa area, then I urge you to consult with a functional and integrative medicine practitioner near you. With an accurate diagnosis in hand, you can begin to treat the root cause(s) of whatever is ailing you and get back on the path to health and happiness.

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Disclaimer: The information in this blog post about HPA axis dysfunction and adrenal fatigue is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from Dr. Matt Lewis, D.C., DACBN, CFMP®, nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.

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About the Author: Dr. Matt Lewis, D.C., DACBN, CFMP®, specializes in diagnosing and treating the underlying causes of the symptoms related to chronic and unexplained illness through nutrition, lifestyle, chiropractic, and other natural approaches to whole-health healing in Tampa, Fla. Dr. Lewis has 20 years of experience practicing nutritional and holistic medicine. He earned his B.S. in Biology from Shenandoah University, his Doctorate in Chiropractic from Life University, his Diplomate status in Clinical Nutrition from the American Clinical Board of Nutrition, his CFMP® from Functional Medicine University, and his certification as a Digestive Health Specialist (DHS) through the Food Enzyme Institute. Dr. Lewis’ passion for health and wellness stems from his own personal experience. With a family history of autoimmune conditions and diabetes, and his own lab tests showing his genetic susceptibility to Hashimoto’s thyroiditis (autoimmune thyroid), he has learned how to restore his own health and vigor to prevent the onset of these and other illnesses and live an incredibly active life. Through this process, he acquired a deeper understanding of health and wellness, which he now offers his patients in Tampa.