HPA Axis Dysfunction
While HPA axis dysfunction is a “newer” term, you might be more familiar with “,” although that particular phrase is fairly controversial.
Adrenal fatigue was a term used to describe what we now know is HPA axis dysfunction, which includes more than just the adrenal glands. Symptoms of fatigue or exhaustion, cortisol imbalance (from testing) along with a history of acute or chronic stress led integrative and functional medicine practitioners to the idea that the adrenal glands were “fatigued” and eventually “exhausted” from constantly producing cortisol during periods of stress — that over the course of weeks, months, or years, the adrenal glands became dysregulated and lost normal function. But through research, medical professionals now know the problem involves more than just the adrenal glands.
While adrenal fatigue isn’t and never has been an accepted medical diagnosis, HPA axis dysfunction is more concrete in its definition and its scientific backing. Here’s what HPA axis dysfunction is, what the condition means for patients, the symptoms they may be experiencing, how you can test for it, and the treatment options available.
What is HPA Axis Dysfunction?
Before we get into the dysfunction portion of this topic, it’s important to understand what the HPA axis is and what parts of the body it refers to.
- Hypothalamus – This part of the brain, located at the base near the pituitary gland, plays an imperative role in many bodily functions. Its main job is to regulate hormone production, which affects a number of physiological processes such as body temperature, emotions, appetite, and sleep (among others). The hypothalamus connects the endocrine system to the nervous system.
- Pituitary Gland – Sometimes called the “master gland,” the pituitary gland is the center of the endocrine system. It takes information from the hypothalamus, makes hormones the body needs, and disperses this information to other glands in the body so they can perform their own essential functions.
- Adrenal Glands – The adrenal glands are located just above the kidneys. Based on information received from the pituitary gland, the adrenals are in charge of making necessary hormones. While the adrenal glands produce many hormones, the most closely associated hormones with these small glands are adrenaline and cortisol.
These three areas of the body work together to perform many essential functions across multiple systems, including the regulation of energy and , metabolism, and immune response. None of them are independent, and each relies on the other (at least in some way, if not directly) to function properly. At the same time, any imbalances across these systems can trigger a domino effect where the other systems are affected. There are three hormone classifications that can signal an imbalance:
- Corticotropin-Releasing Hormone (CRH) – CRH is a stress hormone that is also sometimes called Corticotropin-Releasing Factor (CRF). It’s released by the hypothalamus.
- Adrenocorticotropic Hormone (ACTH) – ACTH is released by the pituitary gland. Production of this hormone is triggered by the detection of CRH.
- Glucocorticoids – Glucocorticoids are steroids released by the adrenal glands, and are triggered by the detection of ACTH. There are many types of glucocorticoids, and cortisol is one of them.
An abundance of one particular hormone can potentially cause issues. For example, if your body produces too much cortisol, your body will be “stuck” in fight or flight mode. This can lead to trouble sleeping or insufficient sleep, weight gain and mood changes.
found that HPA axis dysfunction “has been found in a high proportion” of CFS patients. The researchers on that study described the two conditions as being “associated.” The same study found there to be an “increased frequency of HPA axis dysregulation in females,” inferring that gender could play a role in this condition.
While there is still much to be learned about HPA axis dysfunction, the researchers specifically noted that “the need for novel treatment strategies such as those which target the HPA axis is clear.”
For , this is clear. “When it comes to hormones, energy and mood stabilization; the HPA Axis is one of the most critical hormonal communication networks in our bodies. This is something I treat daily in my clinical practice.”
Dr. Margeson calls the HPA axis the body’s control center. “The HPA Axis controls everything from our cortisol and adrenaline and sex hormone secretion (from the adrenal glands) to how our body synthesizes those hormonal shifts (the pituitary) to how it responds to those shifts by releasing different hormones that communicate with our thyroid, our ovaries, our digestive tract, our temperature regulation and even our growth patterns.”
So what does it look like when things aren’t functioning properly in that axis?
HPA Axis Dysfunction Symptoms
There are many different symptoms associated with HPA axis dysfunction, but the most common include:
- Fatigue or exhaustion
- Unexplained weight gain or loss
- Poor quality (even if you’re sleeping, you don’t wake feeling rested)
- (falling asleep or staying asleep)
- Poor immune response
- Difficulty handling and/or managing stress
- Brain fog (not be able to think clearly or remember things)
- Difficulty concentrating
- Increased anxiety
- Depression
- Sugar or salt cravings
- Inflammation
- Poor circulation
- Weak nails (that break easily)
- Hair loss (sometimes resulting in bald patches)
Those that are familiar with the term “adrenal fatigue” may be thinking that these symptoms sound a lot like those associated with that condition. The research community has never been able to find conclusive evidence that the adrenal glands can actually be fatigued. Because of the lack of affirmative research, many medical professionals wouldn’t use such a diagnosis.
What differentiates HPA axis dysfunction from adrenal fatigue as a diagnosis is the research and correlations to other essential functions. The hypothalamus, pituitary gland, and adrenal glands all work together on a daily basis, and it’s known that dysfunction in any of those body parts can cause issues.
According to Dr. Margeson, “When everything is going well, this axis keeps everything stable. This is when our system is relying on cortisol to maintain the status quo. However, when we are overworked, overburdened and aren’t resting and recovering enough (aka burning the candle at both ends), this axis shifts our system into running on adrenaline.”
When you get to that point, your body is already stuck in the fight or flight response. Dr. Margeson describes it like this: “You’re wired, but exhausted at the same time. You crash in the afternoon. You aren’t really that hungry, but then you can’t stop snacking at night. You have to make more lists than normal, your sex drive plummets, you forget simple things, and bright lights really start to bother you. Even though you’re feeling exhausted and overtired, you stay up late because you get a second wind and then you wake up once you fall asleep.”
It’s truly a vicious cycle, and one that is very difficult to get out of. But more on that later.
What Causes HPA Axis Dysfunction?
The major and most common cause of HPA axis dysfunction is prolonged periods of stress. As mentioned previously, when the body consistently releases stress hormones, it doesn’t have enough time to relax. This can occur in the case of chronic stress, emotional trauma, or even unmanaged anxiety.
“One-third of my patients have some degree of HPA axis dysfunction,” says Dr. Brandi Moore, NMD at in Scottsdale, Arizona. Dr. Moore specializes in skin, hormones and digestive health, and has been trained in both naturopathic and conventional medicine. She adds that “stress is the common denominator” between all of them.
People in consistently high-stress situations — medical students, attorneys, CEOs and other C-level executives, and any other high-pressure job are all at risk for experiencing HPA axis dysfunction systems, and Dr. Moore says that they can all use some support in that realm.
HPA Axis Dysfunction Test
There is no official test that can diagnose HPA axis dysfunction in the same way we can test for the flu or strep throat. In order to test the function of these glands, naturopathic doctors, chiropractors, and other alternative practitioners typically test cortisol levels.
Cortisol levels can be tested using urine, blood, or saliva. Dr. Moore uses a saliva test to diagnose her patients.
Because cortisol levels are a major indication of HPA axis dysfunction, the saliva test is done four times throughout the day. Dr. Moore’s test involves the patient spitting directly into four test tubes: “The first time 30 minutes after waking, the second mid-morning, third afternoon, and fourth early evening.”
Upon completion of the collection, the patient will send it to the lab, which will assess the levels of cortisol in each saliva sample. Abnormally high or low cortisol levels, or spikes where there shouldn’t be spikes (like before bed) could indicate HPA axis dysfunction.
HPA Axis Normalization
HPA axis dysfunction is reversible with lifestyle changes. Supplements in addition to important lifestyle changes may also help minimize the effects of this condition.
Lifestyle Changes
The most important lifestyle change you’ll need to make is to reduce your stress level. Depending on what is causing you stress, this may look different for different people.
Practice Yoga or Meditation
A good place to start is by beginning a meditation or (or both). Learning breathing techniques that help keep your stress response under control is a crucial skill to learn in the management of HPA axis dysfunction.
Reduce Primary Stressors
If the main source of your stress is something you can cut out of your life (or reduce significantly), then you should consider doing so. This could mean a job change, speaking to a friend less often, or simply making the choice to find time for yourself instead of overextending your commitments. Otherwise, find a way to channel your stress into something positive that helps you relax.
Make Sleep a Priority
Getting the each night can be difficult for some, but if you’re experiencing HPA axis dysfunction symptoms, it’s critical to make sleep a priority in your life. Getting the physical rest you need will help , and will do wonders for your mental state.
Maintain a Balanced Diet
It’s very important for people experiencing HPA axis symptoms to maintain a healthy . Now is not the time for extreme dieting. Stick to a natural whole food, mediterranean style diet, eat plenty of fruits and vegetables, and stay away from processed foods, sugar and white flour as much as possible. And of course, drink plenty of water to maintain good hydration.
One thing you may want to avoid (or limit) for at least a little while is alcohol. As alcohol is a depressant, it might be a good idea to limit your intake for a bit.
Exercise
Exercise can be a big stress reliever. Get up and get your body moving for at least 30 minutes each day. It doesn’t have to be rigorous or difficult, but you should do something you enjoy — something that helps you relax and clear your mind. It may be walking, hiking, or biking (even if it’s on a stationary bike), or some light weight training. The point is to move your muscles, increase your circulation, breathe deeply and relax your mind. Exercising daily also helps you sleep better.
Supplements Which Support HPA Axis Function
The most universally accepted supplements for supporting the HPA axis are vitamin C, B-vitamins and adaptogenic herbs.
actually help to counteract the effect that stress has on our bodies by working to stabilize the hypothalamus, pituitary gland, and adrenal glands. Specifically, adaptogens help to support the body for better resilience, repair, and homeostasis (equilibrium).
When we feel stress (whether it’s negative, like losing your job or positive, like lifting weights), our bodies go through three stages to adapt and find a state of normalcy again. After the stressor, the adrenal glands produce adrenaline to fuel the body through the crisis. When it’s over, our bodies need to return to equilibrium.
Some adaptogens help prolong that “shot of adrenaline” feeling so that our bodies can harness extra strength and clarity for a longer period of time. And some adaptogens help people maintain more calmness in the face of daily stressors or triggers. All adaptogens help the body respond more normally to stress, and return to a sense of calm and wellbeing faster.
that adaptogens have multiple positive effects on animals and isolated neuronal cells, such as:
- Neuroprotective components
- Anti-fatigue capabilities
- Mood stabilizing abilities
- Improve cognitive function
- Stimulate the central nervous system
Adaptogenic Herbs
Adaptogenic herbs grow in every part of the world, which is why there are many to choose from. Each adaptogenic herb on this list has different potential benefits, but not every one of them will suit every patient’s unique needs.
- (also known as Siberian ginseng or Eleuthero)
- (also known as Golden Root or Rose Root)
- (also known as Jiaogulan)
- Panax Ginseng
- /curcumin
Why Some Doctors Are Hesitant to Diagnose
HPA axis dysfunction is a more accepted diagnosis than adrenal fatigue ever was, but because most primary care physicians may treat each symptom individually, they may not be looking for the underlying cause.
However, integrative and practitioners have known about and have been addressing this condition for at least a decade. They know what it looks like, so they’re better equipped to diagnose it. Integrative experts aim to get to the root of the problem and help correct it, rather than just mask the symptoms.
If you are experiencing symptoms of HPA axis dysfunction, you might want to find an integrative practitioner, nutritionist or functional medicine doctor in your area who is familiar with this condition.
But in the meantime, it wouldn’t hurt to make some healthy lifestyle changes to see if they make a difference in how you feel day-to-day. Get more sleep, reduce your stress levels, eat healthier, and get some exercise.
Would you like to learn more about HPA axis dysfunction or adaptogenic herbs? Check out these articles with additional pro tips: