And It's About Time There Was Some Support For Cushing's!
The symptoms of adrenal fatigue are similar to Cushing's.
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by Ron Kennedy, M.D., Santa Rosa, California
Life is one stress after another. Most people, not living on an isolated South Pacific island, would agree with that statement. Stress, along with poor diet, ingestion of substances unnatural to the human body (prescribed synthetic drugs, unprescribed street drugs, tobacco, coffee, etc.) and lack of exercise accounts for most diseases from which people die in this society.
Stress is not something new. It has been around for as long as we humans have been around. A cold winter is stressful, even if you have a warm house and warm clothes. A super-hot summer is stressful. All illnesses are stressful. Being confronted by a lion (or your boss) is stressful. Financial worries, or any worries for that matter, subject the body to stress. Taking a test is stressful. Arguing with your mate is stressful. Simply feeling cheated is stressful.
The role of stress has been extensively documented in heart disease, cancer, even automobile accidents. From time immemorial, stress has been a major killer of human beings. It would, therefore, be strange if nature had not developed in us an organ charged with the responsibility for responding to stress.
The name of these organs is the adrenal glands. Nature considers response to stress to be so important that she has developed in us two of these organs, in case one of them is damaged. They sit on top of the kidneys on each side. They are shaped like your cupped hand held facing down, and they are just a bit smaller than your hands.
The adrenal glands are functionally several glands existing anatomically as one, one on each side that is. The innermost part is called the adrenal "medulla." This part makes the catecholamines: epinephrine and norepinephrine (also called "adrenalin" and "noradrenalin"). These hormones are elevated in response to acute distress: overwhelming fear and/or anger. They supercharge the body for vicious fighting or an all-out run for safety. They cause an immediate outpouring of ATP, the molecule which stores energy in muscles. This makes you extraordinarily strong for a short period of time.
The catecholamines are stressful in themselves, if they are released inappropriately. Inappropriate release happens when you take an animal (like a human being) and civilize it by prohibiting the expression of anger and fear. Many people are stressed by not being able to express themselves. In these cases, metabolism is shifted from aerobic to a combination of aerobic and anaerobic, a method approximately eighteen times less efficient in energy production.
After the initial rush of fight or flight energy, it is in the body's best interest that the catecholamines simply go away. Unfortunately, as we grow older catecholamines levels rise progressively and, at the same time, there is a decrease in the levels of hormones which balance the catecholamines: testosterone and hydrocortisone. This shift in hormones, as we age, subjects us to a constant low-level stress.
Fortunately, there is more to the stress response than the adrenal medulla with its catecholamines. Nature has invented the adrenal cortices as a mechanism for dealing with chronic stress (stress lasting for more than a few minutes).
The adrenal cortex on each side fits over the adrenal medulla and is designed to respond to all stresses which are not of the acute variety. They do this by manufacturing steroid hormones (cortisone, hydrocortisone, testosterone, estrogen, 17-hydroxy-ketosteroids, DHEA and DHEA sulfate, cholesterol, pregnenolone, aldosterone, androstenedione, progesterone and a variety of intermediary hormones). The adrenals are the major steroid factories of the body.
The actions of most of these hormones are dealt with in other chapters. I want to focus here on aldosterone, cortisone and hydrocortisone. Most of the hormones made in the adrenal glands are made also at other locations in the body; however, these three hormones are made only in the adrenal glands and are the most important for the chronic stress response.
Aldosterone is the so-called "mineralocorticoid" and while you read of the mineralocorticoids, aldosterone is the only one. Aldosterone works together with the kidneys to regulate the balance of minerals in the body. The proper balance of minerals is critically important in the healthy stress response.
Cortisone and hydrocortisone are the major "glucocorticoids." They help regulate the level of glucose in the body through a process known as "gluconeogenesis." This word means, literally, "glucose new creation" and this is accomplished by the conversion of protein to glucose.
This physiology is especially important for the immune system and, in the presence of weak adrenals, the immune system is seriously impaired. This opens the way for a variety of bizarre infections, which could never get a foothold in the body in the absence of compromised adrenal glands. Anyone who is especially susceptible to infections probably has weakened adrenals, thyroid gland, or both — therefore, a weakened immune system.
The incidence of autoimmune disease also goes up in the presence of weak adrenals. It may be that the adrenal glands regulate the immune system in such a way that autoimmune disease is not allowed to develop. When the adrenals become fatigued, this regulation may be relaxed and the immune system allowed to attack certain cells of the body as if they were foreign invaders. At any rate, it is well-known that certain hormones of the adrenal gland are useful in the treatment of autoimmune diseases such as rheumatoid arthritis, lupus and scleroderma.
In a normal condition, the adrenal glands are loaded with aldosterone, cortisone and hydrocortisone; so when there is stress and more energy is needed, these hormones are released, the energy is released, the problem is handled, and we return to a relaxed condition.
However, the adrenal glands are made for just so much stress. If this level of stress is exceeded, the adrenals respond as well as they can — they make all the aldosterone, cortisone and hydrocortisone which they can make, release it, make some more, release it and so on. Finally, they become exhausted, and you have to take a few days off work — you just "cannot take it any more." You recover after a few days' rest, and you are good to go again, but then the cycle repeats itself.
After a few months or years of chronic stress the adrenal glands become weak. Even after a rest they are unable to respond to stress in a normal manner. The most common clinical manifestation of this condition is chronic fatigue, a condition which is increasing in our society at an alarming rate.
Other signs of weak adrenal function are overeating and weight gain, also conditions rife in our society. When the adrenals are completely nonfunctional, the result is weight loss, excessive loss of salt from the kidneys and abnormally low blood pressure. This condition is most commonly seen in females. A tall, thin (for some reason blond) woman with low blood pressure is suffering from Addison's Disease (adrenal failure) until proven otherwise.
Medical thinking has polarized on the subject of adrenal function, so that, in the minds of most doctors, a person is either in a normal condition or has Addison's Disease (complete adrenal failure) with no possibility for middle ground. This polarization came about in the early days of treatment with adrenal steroids, the 1950s, when cortisone and hydrocortisone became available. Doctors did not know the proper dosages, guessed too high, got serious side effects and became phobic about the use of adrenal steroids.
To allay their fears of disaster, they created a kind of myth that patients were only allowed to have complete failure of the adrenals or nothing at all. If this were the case, and a person shows up with complete failure of the adrenals (Addison's Disease), naturally the only thing to do would be to treat with adrenal steroids. If failure is not complete, the patient is defined as "normal" and not treatable.
In this manner, the fear of being sued for inducing the side effects associated with abnormally large doses of, for example, hydrocortisone is taken away by the fact that no one receives this therapy except the patient who has complete adrenal failure. In that strange world, it is is better to have complete adrenal failure than to have partial adrenal failure — because in that case a person at least receives treatment.
It seems far more likely to me, and to many other authors in progressive medicine (not to mention every other health discipline), that there is a middle ground called adrenal fatigue. Total adrenal failure to function (Addison's Disease) probably is a condition having something to do with incomplete development of the adrenal glands during the embryonic stage of life, or destruction of the adrenal glands by a disease process, for example, tuberculosis.
The diagnosis of adrenal fatigue is made through an adrenal panel (measurement of the level of a variety of adrenal hormones), although, just as with thyroid dysfunction, "normal" levels may be insufficient for the stress to which that person is subjected. Resting (nonstress) levels bear little relationship to the adrenal glands' ability to increase production to counter the effects of stress. The diagnosis can be made with an ACTH challenge test. ACTH (adrenal corticotrophic hormone) is the pituitary hormone which commands the adrenal cortex to produce hormones. By giving a dose of ACTH, we expect to see a doubling of adrenal hormone output, at least. If this does not happen, adrenal fatigue is probable. In extreme adrenal fatigue, the levels actually fall, demonstrating the "whipped horse" phenomenon.
A person who becomes exhausted after stress, and remains exhausted, should be considered adrenal fatigued, until proven otherwise. The diagnosis can be suspected when the patient reports that he is exhausted for days after vigorous exercise. A person who used to run three miles, four times each week, who can no longer tolerate running one mile without being out of commission for days to weeks, is highly suspect of having fatigued adrenal glands. From here I suggest you go to Treatment of Adrenal Fatigue and Addison's Disease.
