Sometimes when we endeavor to understand complicated medical topics, we attempt to find a simple explanation to cut through the complexity. Oftentimes these explanations can help bridge the gap for awhile, but then, the more we learn about the subject, the explanations lose some of their original usefulness. We are all familiar with the good/bad cholesterol (over)simplification of atherosclerosis and heart disease. Most of us have long since abandoned this simplistic view of risk assessment in cardiovascular disease, but it is still the leading paradigm for most patients, as well as in guideline recommendations and in pharmaceutical advertisements.
Since this isn’t a blog about atherosclerosis, I will shift over to the subject at hand: is “adrenal fatigue” an oversimplified title for the dysfunctional stress response system? Well, as it turns out, this is great question and one that a few colleagues and I are in the process of answering in our review article on this topic (coming soon). The reason it is a good question is that while we often measure the outcome of adrenal activity (cortisol and DHEA-S) to assess the stress response system, the dysfunction is more often in the brain’s (hypothalamus and pituitary) control of the adrenal glands’ output. Just as we often claim that those only focusing on Addison’s disease or Cushing’s disease (disease of the adrenal gland) have missed the big picture, we may also be guilty of this by focusing only on “Adrenal Fatigue” or “Adrenal Exhaustion”.
So what is a better name? Well, first of all I think we should always think of the HPA axis (hypothalamic-pituitary-adrenal axis) acting together rather than thinking of the isolated functions of the adrenal gland. It is often the dysfunctional adaption of the feed-forward or feedback signaling at the brain level that leads to inappropriate levels of cortisol, and less often the inability of the adrenal glands to produce cortisol. We have also learned that as with most hormone systems, cellular resistance to hormones and receptor expression plays a role in HPA axis adaptation and (dys)function.
If we are successful in our review article, we will be able to reframe the knowledge that has been gathered on the clinical benefit of measuring and treating HPA axis dysfunction that results from “stress,” and help create a modified nomenclature that will better define the clinical reality. Users of the ARK Program will then be able to help us adjust patient education so they can better understand how stress is affecting their health.
I am looking forward to hearing your comments.