Adrenal Stress Profile test result - What does it mean?

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Understanding DHEA test results is easy. Low levels show a deficiency and DHEA supplementation is indicated.

Cortisol is more awkward. Levels vary according to the level of stress and for how long that stress has been applied. Increasing cortisol production is the normal response to stress and is highly desirable, so long as the stress is removed so that the adrenal glands can recover. On-going, unremitting stress means the adrenal gland and the whole body are in a constant state of alert, the adrenal gland does not get time to recover, and eventually it packs up. So, there are several stages of adrenal function gradually leading to complete adrenal failure.

What does my test result show?

1. Normal levels of cortisol and normal DHEA.

Normal result. Normal adrenal gland.

2. Raised cortisol and normal DHEA.

This indicates a normal short term response to stress. So long as the stress is removed, the adrenal gland will recover completely. The adrenal gland is functioning normally but the patient is acutely stressed.

3. High levels of cortisol and low levels of DHEA.

The body cannot make enough DHEA to balance cortisol. This is the first sign of adrenal exhaustion. This is a normal response to chronic stress as the adrenal gland switches from DHEA production to cortisol production instead. However the patient needs a long break from whatever that chronic stress may be: insomnia; mental; physical or emotional overload; poor diet; or whatever. Failure to correct leads to exhaustion. I used to treat DHEA deficiency with DHEA. However, I believe pregnenolone is more physiological because it is upstream of all adrenal hormones including progesterone and cortisol but it must be part of a package of recovery without which worsening can be expected.

4. Cortisol levels low and DHEA levels low.

The gland is so exhausted it can't make cortisol or DHEA. By this time patients are usually severely fatigued. Very low levels indicate Addison's disease - complete adrenal failure. Untreated Addison's disease inevitably results in death.

5. Cortisol levels low and DHEA borderline or normal.

This probably represents the gland beginning to recover after a long rest. Pregnenolone may be used to help patients feel better whilst they continue their programme of rest and rehabilitation.

In practice, the interpretation is often not so straightforward because cortisol levels fluctuate through the day in response to the stresses of daily life, peaking in the morning and falling as the day progresses.

I do sometimes see patients with low cortisol levels who do not have overt Addison's disease. Some do respond to cortisol, but I would use sub-physiological doses - ie. up to, but not more than 10mgs a day (usually 5mgs). (Please note that the usual steroid used in medicine is prednisolone - 5mgs of prednisolone is equivalent to 20mgs of hydrocortisone). Both these are prescription-only drugs.

With Addison's disease in the event of acute infection or stress, the dose of steroid has to be dramatically increased. This is not necessary in patients taking these sub-physiological doses of hydrocortisone.

I am aware that DHEA is still in the experimental stage. I do believe it is safe in physiological doses.

After 3 months if the patient wishes to continue taking DHEA then the level needs to be re-checked. If it is within the normal range then it can be next checked in one year's time on the same daily dose of DHEA.

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