Transcript of Video:
 

Hi. I’m Dr. Christopher Mote, and this is another installment of the ARK Clinical Pearl. Today, I want to talk to you about Stage 2 of the three stages of HPA axis dysfunction. It’s the test that’s most commonly misinterpreted as a normal test. 

Each of the three stages of HPA axis dysfunction is indicated by a low DHEA, which tells you that you have a patient who’s in Pregnenolone Steal. This is a clinical model that helps us to understand the patient has more stress on the system than their body’s able to cope with, and, thus, they have HPA axis dysfunction. And, again, that’s recognized by a low DHEA. 

What helps us to see a Stage 2 is that the cortisol sum falls within the reference range. And whenever that happens, we call that a cortisol-dominant stress adaptation. It’s not a normal test. When you have cortisol and DHEA that are tracking together, that may be a normal test. But those patients don’t frequently come into the office complaining of symptoms. 

When they have symptoms, and we have a cortisol sum in-range, it’s not a normal test. It is a cortisol-dominant stress adaptation or Stage 2 HPA axis dysfunction. Something else to know about these patients is that they represent 75 to 80 percent of your patients, in total, who do these tests. It’s a very common test result. 

If you take a look at these patients though, it’s helpful to know if they’re on the early side, or Stage 1 hyper-cortisol, or further down the scale in Stage 3 hypo-cortisol. And you can pick that out by looking at the tests, particularly the noon and the afternoon samples. 

If either one or both are below the reference range, they’re really closer to a Stage 3 hypo-cortisol state. And that’s important to know.  Because those patients are going to take a little longer to get better, and you’re going to have to be a little more patient with them. 

So the bottom line is that Stage 2 HPA axis dysfunction, or a cortisol-dominant stress adaptation, has a low-normal or below normal DHEA with a cortisol sum that’s still in range. 

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