Stress & the Adrenal Glands – Why Test Cortisol?

Stress is pretty much unavoidable, which is why the body has processes in place to help manage it. The adrenal glands (small glands that sit atop the kidneys) are the major player in the body’s stress response. They respond to stress by secreting hormones like adrenaline and cortisol. The way these glands respond to stress can be broken down into 3 main stages: the alarm stage, the resistance stage, and the exhaustion stage (aka “adrenal fatigue”).

The alarm stage: In the alarm stage, you get short bursts of stress hormones released in response to an acute stressor, resulting in the “fight, flight or freeze” responses. These hormones influence you to stand up and fight, run away or play dead in the presence of a stressful event. Evolutionarily, these stressors used to be life or death. Nowadays, we deal with chronic, low-grade stress every single day.

The resistance stage: This chronic low-grade stress leaves many of us living in the resistance stage, in which cortisol – our long-term stress hormone – remains chronically elevated. Your body does this to help you physically resist the stressor. This is okay short term, but long-term, high cortisol can leave you feeling tired but wired, anxious and have trouble sleeping. Excess cortisol also interferes with many of our other hormones, including the thyroid, sex hormones like progesterone and testosterone, and can lead to erratic blood sugars, elevated blood pressure, bone loss and more.

The exhaustion stage: Over time, your adrenals can no longer keep up with the demand of cortisol and as a protective mechanism down regulates the secretion of cortisol. Symptoms of low cortisol include fatigue (feeling burnt out – no longer wired), decreased recovery from exercise, increased colds and flus, low mood and depression, low libido, and more.

Why test cortisol? Testing cortisol can provide a very clear understanding of exactly where you are at. Your body does not suddenly go from resistance to the exhaustion stage, it happens over time, meaning that you may have points in the day where cortisol remains high (e.g. before bed), and other times where cortisol output is low (e.g. morning). That is why I suggest having urine or salivary cortisol tested at 4-5 different time points in the day vs. the classic 8 AM blood sample that is conventionally done to assess for Addison’s and Cushing’s disease. Addison’s and Cushing’s can be life-threatening conditions; the tests I am referring to here are to catch everyone in the middle. It is what we call functional medicine. Many patients come into my office confused as to why their lab work appears normal but they know they feel unwell. Functional medicine tests can help us determine what is no longer functioning optimally and to treat it with an individualized approach.

In health,
Dr. Willow