You may have heard of adrenal fatigue.  Nutritionists, alternative practitioners, and lay people have been talking about it for a while — and doctors have mostly been saying, “that’s not a thing.”  Except it is…it’s HPA axis dysfunction.  And for whatever reason (perhaps because “HPA axis dysfunction” sounds more scientific), it seems to be taken more seriously by this name.

(There are even journal articles about it!  This is good news for those with chronic, invisible illnesses like Chronic Fatigue Syndrome, which has been associated with HPA axis dysfunction.)

So…What in the World is the HPA Axis?

The HPA axis is the hypothalamus, pituitary, adrenal axis.  Obviously, that’s a bit of  mouthful, which is why we shorten it!  (Although “HPA axis dysfunction” is still a bit unwieldy; “adrenal fatigue” is easier altogether!)

The hypothalamus, pituitary gland, and adrenal glands are all parts of the endocrine system, and they work together when it comes to managing stress and doing the adrenal glands’ other jobs.

The hypothalamus is in the brain.  It regulates sleep, body temperature, hunger & thirst, etc. so the body can maintain balance.

The pituitary gland is near the brain, and its major roles are to regulate growth and maturation (e.g. puberty) and to signal other endocrine glands.

The adrenal glands, which sit atop the kidneys, produce hormones that regulate the stress response, metabolism, your immune system, blood pressure, and more.

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The Hypothalamus-Pituitary-Adrenal Axis at Work

These three body parts are supposed to work together in a cascade when responding to stress.

1. The hypothalamus releases corticotropin-releasing hormone (CRH) as a message to the pituitary gland.  (CRH also impacts appetite, anxiety levels, and memory/attention.  It’s released during pregnancy and in small amounts by some white blood cells, so if you see a major shift in symptoms during pregnancy, and/or have elevated WBCs with no other explanation, consider this connection.)
2. This signals the pituitary gland to release adrenocorticotropic hormone (ACTH) as a signal to the adrenal glands.
3. The adrenal glands, in turn, release “glucocorticoids” (a group of steroid hormones) including cortisol.  (Cortisol also communicates to the hypothalamus that it has enough, so this is more of a cycle than a top-down-only issue.)

When it Doesn’t Work – HPA Axis Dysfunction

If any one of these steps breaks down, you have HPA axis dysfunction.  The lay diagnosis (so to speak) will be “adrenal fatigue” because ultimately, the adrenals aren’t working very well.  But it might not be the adrenal glands’ fault (although it might be).

The term “HPA axis dysfunction” better communicates the idea that something in that trio is malfunctioning.  If you’re treating the adrenals, but something “upstream” is actually causing the problem, then you’re (probably) never going to fix it.

Identifying HPA Axis Dysfunction

You’ll often know that HPA axis dysfunction is present based on symptoms!  But all three stages of this cycle can be tested.

Levels of ACTH can be tested. Cortisol can also be tested, and a four-times-in-a-day saliva test should be used (rather than a single reading), so the practitioner can see whether the cortisol rhythm is normal over the course of a day.

There’s also a corticotropin-releasing hormone (CRH) stimulation test, where the doctor administers CRH directly, testing ACTH levels before and after to see if the pituitary gland is responsive.  The combination of CRH and ACTH before and after help the practitioner deduce which piece of the cycle is the primary cause of the dysfunction.

What’s the Solution?

Even though the adrenals may or may not be the direct cause of the problem, the good news is, most recommendations for adrenal fatigue are still a good bet.

Many of them are necessary nutrients that nourish the adrenals, which doesn’t hurt (unless you’re overdoing it).  Some address inflammation, which helps make up for the job the adrenals aren’t doing and can potentially contribute to addressing problems with the pituitary gland or hypothalamus.  (In essence, they may help interrupt the “vicious cycle.”)

Still others are about reducing stress, which decreases the burden on the entire HPA axis — certainly a good thing no matter what part of the cascade is instigating the breakdown!

The hypothalamus, being part of the brain, needs “brain food.”  This includes lots of healthy fats, especially omega-3’s (found in high amounts in fatty fish, nuts — especially walnuts, and flax and hemp seeds).

The pituitary gland is, in some ways, also considered part of the brain and needs “brain foods,” too.  It’s also responsible — directly or indirectly — for the production of a number of hormones, so rebalancing out-of-balance hormones can help it function more effectively.

Inflammation can lead to problems in any of these organs/glands, so reducing inflammation is beneficial for any or all of them.  Heavy metal toxicity seems to be one specific cause, so detoxification may be important, as well.

Finding a good practitioner to get tested and build a targeted approach will probably be important if your HPA axis is well out of whack.  But as is true for most things, you can lay a good foundation by nourishing the body with a varied diet of real foods, and pursuing an overall healthy lifestyle.

Legal disclaimer: I’m not a licensed medical professional.  Nothing on this site has been evaluated or approved by the FDA.  All information here is provided for educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease, or as a substitute for appropriate medical care. Use your own common sense and be responsible.