​HYPOADRENIA: The Hidden Diagnosis

by Dr. Hepsharat Amadi

Do you feel more tired than you think you should for your age and activity level?  Do you have low back pain? Any aches, pains or injuries that don’t seem to heal quickly? Can you get out of bed in the morning after 7 or 8 hours sleep and still be tired?  Have you been diagnosed with a thyroid disorder?  Do you have recurrent infections that are never resolved for long? Do you have a slow metabolism or have you been gaining weight? Ever had episodes of dizziness or low blood pressure or episodes of weakness? Are you depressed?  Anxious? Do you have brain fog?

Maybe your problem does not originate with the thyroid.  Maybe it was your body’s adrenal glands that were affected first, by prolonged stress or toxicity or both. Then when the thyroid glands kicked into overdrive to try to support the struggling adrenals, then the thyroid in turn became exhausted and started hypofunctioning. The reasons there are a lot of misdiagnosed or undiagnosed hypoadrenal patients walking around out there is because A) doctors are not trained to suspect a hypoadrenal situation except in the most drastic presentations, such as Addison’s disease, and B) doctors are trained to measure everything including hormones in blood, and blood is NOT the best medium to measure hormones in, saliva is.

Because adrenal hormone secretion has a 24 hour daily circadian rhythm of varying output depending on the time of day, what would be a normal morning cortisol level would be way too high for the evening and a normal evening cortisol level would be too low for the morning. Cortisol release is supposed to be highest in the morning, so we can get out of bed and have enough energy to tackle the day’s work, and lowest in the late night so we can simmer down and get ready to go to sleep. 

Cortisol levels are not routinely measured by most doctors, and even if they do measure them, they are most likely to measure them in blood, which only tells what the cortisol level was at the time the patient was getting their blood drawn at the lab.  Even if that level were totally normal for the time of day when it was drawn, who’s to say what it was during other times of the day when it was not being measured?  Even if the total cortisol production for the day were normal, if too little were secreted in the morning and too much late at night, the person would still have a problem.

Even though TV commercials have cast cortisol in the role of “the bad guy”, blaming excess cortisol for causing weight gain and belly fat, this is only a partial truth.  Like most things in nature, health is characterized by balance: the body needs just the right amount of cortisol not too much and not too little. Too much cortisol over time can cause the deposition in the abdominal area, which is associated with increased risk of cardiovascular disease. But then can follow a stage in which there is too little cortisol, even though belly fat is still present because of previous excess cortisol. When the adrenals burn out, often the thyroid glands pitch in by making more thyroid hormones, and then, over time, the thyroid becomes depleted as well and this causes the production of less thyroid hormones than is normal.  It is at this point that the patient is often diagnosed as being hypothyroid due to abnormal TSH or T-4 or T-3 values in the blood, and then they are given higher doses of pharmaceutical thyroid hormones, like Synthroid. 

Often these patients never have their cortisol levels measured at all, much less in saliva, which is the most accurate method of adrenal hormone testing. Sometimes these patients feel better initially from being started on thyroid hormones, but then they still don’t feel completely back to normal even if all their thyroid labs are within normal limits, often because their weak adrenals have still not been addressed.

What can be done to resolve this very common and debilitating condition?  There are many answers to this which vary according to the individual patient.  Some alternatives include bio-identical cortisol, obtained by a prescription from a compounding pharmacy. This cortisol is NOT the same as cortisone. They are both anti-inflammatory, but cortisone has long term bad effects on glucose regulation, the immune system and bone mass, whereas cortisol (if prescribed in reasonable doses) does not.

Supplements that contain extracts of animal adrenal glands can help replenish the strength of human depleted adrenals.  Also, adaptogenic herbs such as ginseng, astragalus, rhodiola, cordyceps, maca, etc. can also help boost adrenals.  Vitamin B5 (pantothenic acid), Vitamin C and magnesium are supportive to the adrenals as well.  There are also homeopathic remedies that can help the adrenals. Some patients need a combination of the above.

A key element to resolving these issues instead of just managing them is being proactive about being aware of, and limiting, one’s stress Usually it is the meanings we choose to attach to what is happening to us that cause us to feel, or not to feel, stress, not the actual events themselves.

Being aware of, and actively working to reduce your stress levels, is the most effective strategy for improving your health naturally as this is conducive to hormonal balance, a key ingredient for optimal mental, emotional and physical health.  

Dr. Amadi graduated from S.U.N.Y at Stony Brook, did her residency in Family Practice at Bronx-Lebanon Hospital, and has been living in South Florida ever since. She is also a licensed acupuncturist. Located in Coral Springs, she practices wholistic family medicine utilizing quantum biofeedback, nutrition and lifestyle management, supplements and bio-identical hormone replacement therapy. 

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