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5 Stages of Adrenal Fatigue

The development of adrenal fatigue has five distinct phases: adrenal surge, sustained adrenal secretion, the turning point stage, adrenal decline, and adrenal exhaustion. Each of these produces a different effect on the body.

  1. Adrenal surge.

    A stimulus causes a rise in the secretion of cortisol and other hormones such as aldosterone, epinephrine, and norepinephrine from the adrenal glands. This stimulus can be many things, including chronic inflammation and illness.

  2. Sustained adrenal secretion.

    The stimulus becomes constant, which causes more sustained cortisol secretion over time.

  3. Turning point stage.

    In response to the stimulus, the adrenal glands work overtime to maintain the cortisol secretion. Although they're still able to maintain the necessary levels of cortisol and other adrenal hormones, they're beginning to develop fatigue in this stage.

  4. Adrenal decline.

    The adrenal glands begin to tire. They can no longer maintain the high levels of cortisol, and consequently the cortisol levels begin to decline.

  5. Adrenal exhaustion.

    The adrenal glands experience utter exhaustion.

The adrenal surge

The first stage involves a dramatic surge in several adrenal hormones when the adrenal glands are stressed. There are many triggers of adrenal fatigue, including illness, infection, stress, and so forth. Many of them can occur at the same time. That's a lot for your adrenals to take!

Sustained hormone secretion

In the face of one or more chronic stressors, the surge of cortisol secretion is constant and persists for a long time. Consequences of this cortisol surge include the following:

  • A weakened immune system and susceptibility to infections

  • Bone thinning and bone loss, with osteoporosis-type changes

  • High blood pressure

  • Hyperglycemia (higher-than-normal blood sugars) and metabolic syndrome (a constellation of medical conditions including hyperglycemia, high blood pressure, obesity, and high triglycerides.

Note: Cushing's syndrome also produces some of these symptoms.

Aldosterone secretion can increase as well. This hormone, which is produced by the adrenal glands’ zona glomerulosa, is important for regulating blood pressure and volume. A consequence of increased aldosterone secretion in this early stage is higher-than-normal blood pressure.

The secretion of the fight-or-flight hormones, epinephrine and norepinephrine, can increase in this stage as well. As with cortisol, the production of these hormones can be sustained in the face of constant stimuli (such as stress). Many people have elevated levels of these fight-or-flight hormones but don't have any symptoms. Some symptoms that may be present include high blood pressure, a fast heart rate, and palpitations.

Note that many other medical conditions can also cause these symptoms. That's why a holistic evaluation by a healthcare provider is important.

Believe it or not, going to the physician's office can be a cause of adrenal stress. In white coat hypertension, a person's blood pressure increases when he or she goes to a physician's office. This condition isn't benign, because a similar surge of adrenal hormones can occur due to other stressors over the course of the day.

The turning point stage

The third stage of adrenal fatigue is the turning point stage. Two seemingly opposite things occur:

  • The adrenal glands are working hard to maintain constant secretion of cortisol and other adrenal hormones.

  • At the same time, the adrenal glands are beginning to get fatigued; they're starting to become unable to maintain the same level of hormone production as before. The adrenal glands are essentially running out of gas, using a lot of their reserves to keep producing cortisol. People can begin to experience some of the following symptoms:

    • Increased tiredness

    • Hypoglycemia (low blood glucose levels)

    • Lower blood pressure

    • Dizziness and lightheadedness when standing too quickly

Adrenal decline

The fourth stage of adrenal fatigue concerns a decline in adrenal function. The adrenal glands are unable to keep up with the metabolic demands for increased cortisol, so cortisol secretion begins to decrease. The person in this stage can experience the following signs and symptoms due to the decline in hormonal production:

  • Loss of libido

  • Worsening low blood pressure than in the previous stage

  • Increased dizziness and lightheadedness with standing

  • Increased confusion and problems with thinking

  • Salt cravings

The decline in adrenal function can also intensify the harmful stimulus that started the whole process, as the body is becoming more and more unable to deal with it.

In the setting of adrenal decline, if you were to acquire a bacterial infection, for example, you would be more affected by the infection than someone with an intact immune system would. The infection may stay around longer, and you may have more complications as a result of the infection.

Adrenal exhaustion

In the final stage, the adrenal glands are completely wiped out. No more adrenal reserve is left: The adrenal glands have completely run out of gas. Some of the symptoms in this stage are similar to those of Addison's disease.

The person with adrenal exhaustion can be extremely fatigued all the time and be unable to get out of bed or function normally. He or she can be confused and have significant problems thinking.

The adrenal glands are resilient, and with the right testing and personalized treatment plan, adrenal fatigue can be overcome. The challenge for patients and healthcare professionals is recognizing and treating adrenal fatigue early enough, before it progresses to adrenal exhaustion.

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