Adrenal health

Adrenal extremes — could you be on your way to Cushing’s or Addison’s disease?

by Marcelle Pick, OB/GYN NP

• Opposite ends of the adrenal spectrum
• Signs and symptoms of adrenal dysfunction
• What conventional lab tests won’t tell you
• The road to Addison’s and Cushing’s — you’re riding up front

If you’ve read my articles before, you already know that our adrenal glands are crucial to our survival and contribute enormously to our overall health and vitality. When constant stress prevails or other health problems lead the adrenals to work on overdrive, underdrive, or to eventually reach exhaustion, we can suffer dramatically. At the extremes, there’s Cushing’s syndrome (an overproduction of the stress hormone cortisol) and Addison’s disease (an underproduction of cortisol). These conditions can be life-threatening, and will likely be diagnosed and treated quickly. But there is a whole lot of adrenal imbalance in between that is often missed.

What most women don’t understand is that their adrenal imbalance symptoms can be treated long before they ever develop full-blown adrenal disease — and this can make a profound difference to your whole life. The problem is, unless you’ve already reached either end of the adrenal spectrum, most well-intentioned conventional practitioners in the US aren’t trained to help you. It’s so frustrating when I work with a patient on a plan for healing her adrenals, but then she comes back from her conventional practitioner saying, “My doctor doesn’t believe in adrenal fatigue.”

Just because conventional medicine doesn’t have established protocols for testing and treating adrenal imbalance, doesn’t mean it doesn’t exist. We’ve seen this before with gluten sensitivity, which for many years was overlooked or dismissed by conventional practitioners unless the patient had blatant celiac disease symptoms. But gluten sensitivity is starting to be taken seriously — and I suspect that in time conventional medicine will start to recognize adrenal imbalance as well. The human body typically doesn’t just arrive at a diseased state; there are pathways leading to it, with stations along the way. And in the case of Addison’s and Cushing’s, you may be able to halt the progression by identifying adrenal dysfunctions before they reach the crisis point. Let’s take a closer look at these adrenal extremes, the gray zones between them, and how you might avoid an adrenal crisis.

Opposite ends of the adrenal spectrum

Even way back when I was a student, I found it difficult to simply accept a diagnosis and carry out the prescribed treatment plan without digging a little deeper. Instead of simply taking a disease at face value, I’ve always wondered, How did this patient get there? And Could we have stopped the progression? It’s true that certain health issues beyond our control can cause Cushing’s syndrome and Addison’s disease, but I’ve learned that there are also many factors within our reach that influence them.

Cushing’s syndrome (also called hypercortisolism) is caused by long-term exposure to high amounts of the stress hormone cortisol. A more comprehensive list of Cushing’s symptoms can be found in the chart below, but patients with this disorder often acquire some distinct features: their faces are moon-like in shape, their bodies are very round in the middle, and they sometimes have a fatty hump at the back of their necks. Patients with Cushing’s can also feel anxious, irritable, or depressed. In other words, this syndrome truly affects both the physical and the emotional. And most of what you’ll read about the origins of Cushing’s explains that it is generally caused by taking steroid hormones like prednisone (which is chemically similar to human cortisol) for a long period of time. In other cases, there may be a tumor in the brain or the adrenal gland causing the increased cortisol release.

But there are other patients who are simply producing too much cortisol in their bodies. If we look at common complications of Cushing’s — type 2 diabetes, obesity, poorly controlled blood sugar, high blood pressure, and metabolic syndrome — it’s clear to me that there is a connection between diet and Cushing’s. And it makes sense, because when blood sugar spikes (as it does with refined carbs and sugary foods), so does insulin, leading afterward to a dramatic drop in blood sugar. In this situation, the adrenal glands must pump out cortisol to mobilize glucose into the blood stream, so we can function. If this is happening over and over again, you can see how cortisol could be overproduced. Cortisol is produced in abundance when we’re experiencing any kind of stress, so it may not be just an energetic crisis like what I’ve described above, but also psychological or emotional stress influencing your risk for Cushing’s.

At the other end of the spectrum, Addison’s disease (also called hypocortisolism) is a disorder where the adrenal glands don’t produce enough cortisol and other glucocorticoids. There are several ways to get to this point as well. Most conventional practitioners will explain that Addison’s is caused by either a lack of ACTH (adrenocorticotropin), which is the pituitary hormone that stimulates the adrenal glands to pulse out cortisol, or a localized problem, such as a tumor, surgery, or infection causing a breakdown in the messaging to release cortisol. There’s also the possibility of the body’s own immune system attacking the outer cortex of the adrenal glands (called autoimmune adrenalitis).

Yet, as you can see from the list to the right, several other common conditions can predispose us to adrenal insufficiency, like hypothyroidism, diabetes, and anxiety! And our on-the-go lifestyles don’t help. Very few conventional practitioners in this country recognize adrenal fatigue, or the more serious adrenal exhaustion, which is basically “subclinical Addison’s,” the state bordering Addison’s disease. But adrenal fatigue is something I see in my practice all the time. Adrenal fatigue expert Dr. James Wilson explains that there are four basic patterns leading to adrenal fatigue:

1. A prolonged period of resistance, finally giving way to adrenal fatigue.
You could say this is typical of “the stoic,” who bears up to everything life has to throw at her but blows out her adrenals with a final life stressor — “the straw that broke the camel’s back.”

2. A single life blow, major or minor, followed by chronic, ongoing adrenal fatigue.
This pattern might be typical of those whose adrenal reserve was weak to begin with. You may have heard someone say, “Poor thing, she never got over x…”

3. Cycles of recurrent adrenal fatigue, with intermittent but partial recovery.
This is a characteristic pattern of those whose constitution is strong. They may give and give, but despite warning symptoms refuse to change. Such cycles can also result from forces of circumstance — “a series of unfortunate events.”

4. Slow decline into adrenal dysfunction.
In this case, life’s urgent stressors just grind down a person’s resistance to stress gradually, to a point where they end up with subclinical Addison’s.

The great news is that in all the above cases of adrenal fatigue, recovery is possible. I’ve helped many women through the process of healing adrenal imbalance. Yes, it takes some time and commitment. But not only can we prevent a much larger adrenal crisis from developing, every aspect of your life will brighten up when your adrenals get the support they need. After all, these are the organs that help you deal with stress!

Signs and symptoms of adrenal dysfunction

You’ll find a chart below listing some of the symptoms that come with various adrenal dysfunctions. Cushing’s lies at one end of the spectrum and Addison’s at the other. The two way-stations in between are not generally recognized by conventional medicine. Know that there is a wide range of scenarios and patterns in adrenal imbalance between the two extremes. If any of these signs and symptoms of adrenal dysfunction look familiar to you, you can read more about adrenal health on our website or schedule an appointment with a functional medicine practitioner.

What conventional lab tests won’t tell you

Unless you visit your practitioner with classic Cushing’s or Addison’s symptoms, your adrenal function probably won’t be tested. And if you are tested, be mindful of the fact that the conventional lab tests in the United States are set up to detect disease states. So a woman whose numbers don’t fall at the extreme ends of the bell curve will be assumed normal, and the practitioner will likely move on to another possible diagnosis. What’s troubling to me as a functional medicine practitioner, is that there are thousands of people who live their lives struggling with subclinical adrenal dysfunction and are unable to get any help.

If I suspect an adrenal imbalance or adrenal insufficiency in a patient, I measure cortisol levels at several points in a 24-hour cycle with a panel of saliva tests. We do this because cortisol output has a diurnal rhythm to it, where it is typically elevated in the morning to help us get moving, then slowly declines throughout the day to help us prepare for sleep. With this style of testing, I can often detect and address adrenal imbalance before a major problem has occurred.

Blood pressure readings can also give us clues about adrenal insufficiency. If your blood pressure drops dramatically, with dizziness and lightheadedness when you stand up from a seated or lying-down position, this may be a sign that your adrenals are compromised.

If more practitioners were mindful of the need to investigate variations in adrenal function instead of focusing on the extremes, I believe we’d see a much more vital, energetic, and stress-resilient population. Because your adrenal glands serve many crucial and secondary functions alike, healing adrenal imbalance can make a tremendous difference in your whole-body health, including your thyroid, libido, and ability to face whatever challenges and opportunities life may send your way.

The road to Addison’s and Cushing’s — you’re riding up front

What your practitioner may not tell you is that your adrenal health rests primarily on quality nutrition and lowering stress. This is good news, because we can do something about these two aspects of our lives! I tell my patients that if we can address what they’re eating and manage their stress, they will be on their way to happier, healthier lives. I promise.

Science tells us that cortisol is released in higher amounts when we are anxious or under stress, and this can be any kind of stress. Many women don’t understand that diet is another form of stress in the body. If insulin and blood sugar are consistently on a rollercoaster because of highly refined carbohydrates and sugar, cortisol is responsible for leveling things out. After a while, the adrenals will tire of having to come to the rescue. Add emotional and psychological stress on to this and it only makes things worse. Over time, your body can go from a state of cortisol dominance to the eventual adrenal-exhausted state of low cortisol.

You can make real changes in your life that support your adrenal glands before something goes wrong. Easy, natural steps you can take today include eating for your adrenals and exploring herbs to support your adrenals.

On our way to adrenal awareness

I’ve been in practice a long time, and I’m slowly starting to see more and more endocrinologists pay attention to the adrenal glands. The author of a recent New England Journal of Medicine article urged clinicians to become more aware of the “growing list of causes and predisposing factors” that lead to adrenal insufficiency. It is my hope that in the near future, conventional medical circles will acknowledge the full adrenal spectrum, rather than two isolated conditions. Let’s face it: life is becoming increasingly stressful in terms of low-quality food, 24/7 technology, and less time to unwind and relax, so I’m seeing more and more adrenal imbalance in my practice. It’s time for us to slow down and take care of these tiny glands — when we do, our bodies will thank us!

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Last Modified Date: 04/15/2011
Principal Author: Marcelle Pick, OB/GYN NP