HPA Axis Dysfunction:The problems with cortisol come when levels are chronically elevated - or chronically low. There are two conditions of extreme cortisol dysregulation: Cushing's syndrome and Addison's disease. Cushing's is due to too much cortisol, either from glucocorticoid medications or too much cortisol produced by the adrenals due to a pituitary tumor. Symptoms of Cushing's include high blood pressure, abdominal weight gain, round face, stretch marks, thin skin, and, in women, facial hair, and menstrual irregularities. Addison's is due to too little cortisol production. Symptoms include weight loss, muscle weakness, nausea, and changes in mood.
Symptoms of HPA (hypothalamic–pituitary–adrenal) axis dysfunctionWhile Cushing's and Addison's show the extreme's of cortisol disorders, there are milder manifestations that plague many of us. HPA axis dysfunction can mean cortisol is chronically elevated and/or it doesn't respond appropriately to stress. It can also be due to a disrupted rhythm of cortisol production over the course of a day. Chronically elevated cortisol can be due to repeated stress (physical or mental), genetic variants (below), and traumatic childhood events (epigenetic trigger).[ref ] Chronically elevated cortisol is linked to:
- diabetes, insulin resistance[ref ][ref ]
- immune dysfunction[ref ]
- depression and anxiety[ref ][ref ]
- coronary artery disease[ref ]
- reproductive problems[ref ]
- weight gain[ref ][ref ]
Childhood traumaI mentioned above that cortisol levels are controlled by three factors: genetics, chronic stress, and childhood trauma. There is quite a bit of scientific evidence showing childhood trauma can cause persistent changes in the HPA axis. One study describes it as the brain becoming sensitized, thus allowing episodes of depression to occur more frequently.[ref ] Childhood trauma can be mental or physical – from child abuse to a parent dying to having childhood leukemia. Genetics interacts with this, and some people are more resilient to childhood trauma than others. Certain genetic variants cause a higher basal cortisol level with a blunted response to actual, acute stress. This increases the risk of depression, anxiety, and PTSD.[ref ]
Adrenal fatigue: is it real?Adrenal fatigue is an idea promulgated by alternative medicine practitioners. The idea is chronic stress causes the adrenals to wear out - become exhausted - and not be able to produce enough cortisol. This is thought to cause overall fatigue, depression, weight gain, brain fog, etc. Examples of alternative health sites writing about adrenal fatigue: Dr. Northrup's adrenal fatigue article, Dr. Wilson's adrenal fatigue website, Dave Asprey - Bulletproof - chiming in on the adrenal fatigue idea. This is just a handful of examples, and all the big alternative health websites used to be on the adrenal fatigue band-wagon. Most endocrinologists don't think that adrenal fatigue is real. And research studies back up the idea that the adrenal glands aren't worn out, exhausted, or not producing enough cortisol.[ref ][ref ] In fact, some alternative medicine practitioners seem to be re-vamping the way that they talk about adrenal fatigue and now are morphing their articles to talk about HPA axis dysfunction. [article][article]
Genetic Variants in the HPA Axis
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