Adrenal Function

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida

Adrenal function is an essential component of the body’s endocrine and stress-response systems. At Intercoastal Health, we assess adrenal function through a clinical and functional medicine lens, using biomarker data and patient-centered evaluation to guide treatment decisions. When adrenal function is disrupted—whether by chronic stress, poor sleep, inflammation, or nutrient imbalances—the consequences can be widespread, affecting physical, metabolic, and emotional well-being.

Background: The Role of the Adrenal Glands

The adrenal glands are two small glands that sit atop the kidneys. They are responsible for producing a range of hormones, including:

• Cortisol – Regulates stress response, glucose metabolism, and immune function

• Aldosterone – Manages sodium and potassium balance and blood pressure

• DHEA (Dehydroepiandrosterone) – Precursor to sex hormones and modulator of immune function

• Adrenaline and Noradrenaline – Key players in the acute “fight or flight” stress response

Adrenal function is not static. These glands are highly responsive to internal and external stressors. Chronic or unresolved stress can impair their performance, leading to either overactivity (adrenal hyperfunction) or underactivity (adrenal insufficiency/hypofunction).

Clinical Presentation

Adrenal Hypofunction (Adrenal Insufficiency)

Adrenal hypofunction is characterized by a reduction in cortisol and DHEA output. This can cause a range of symptoms associated with low metabolic function and poor stress resilience.
Common Signs and Symptoms Include:

• Fatigue and low energy

• Hypoglycemia, sugar cravings, and reactive hunger

• Low blood pressure or dizziness

• Salt cravings

• Poor concentration, memory, and mood (e.g., depression, irritability)

• Menstrual irregularities and PMS

• Chronic inflammation and allergies

• Alcohol intolerance

• Digestive discomfort (e.g., bloating, dyspepsia)

• Prolonged recovery from illness

Adrenal Hyperfunction (Adrenal Stress Response)

Conversely, adrenal hyperfunction involves elevated output of cortisol and/or aldosterone. This condition can initially be adaptive, but over time leads to metabolic imbalance and immune suppression.
Common Signs and Symptoms Include:

• Abdominal weight gain

• Insomnia and trouble winding down

• High blood pressure

• Elevated blood sugar and insulin resistance

• Immune suppression (e.g., recurrent infections, chronic viral presence)

• Muscle wasting and osteoporosis

• Headaches, hot flashes

• Increased LDL cholesterol

• Hormonal imbalances and excessive hair growth (females)

• Teeth clenching, anxiety, and emotional instability

Biomarkers for Assessing Adrenal Function

Biomarker testing is a foundational tool in evaluating adrenal function. At Intercoastal Health, a combination of blood and urine assessments are used to detect dysfunction and guide clinical recommendations.
Key Biomarkers Include:

• Cortisol (Total/AM/PM): Assesses diurnal variation and total output

• DHEA-S: Reflects anabolic-adrenal balance

• Aldosterone: Regulates fluid and electrolyte balance

• Potassium & Sodium: Imbalances can reflect adrenal dysfunction

• Sodium/Potassium Ratio: Helpful in assessing mineralocorticoid activity

• Chloride: Can provide insight into acid-base status and fluid balance

Additional tools may include:

• ACTH stimulation test: Measures adrenal gland response to pituitary signals

• 24-hour urinary free cortisol: Captures cortisol production trends

• Imaging (CT/MRI): When structural abnormalities of the adrenal or pituitary glands are suspected

Clinical Implications

Adrenal dysfunction can play a role in the development or exacerbation of several chronic conditions, including:

• Cardiovascular disease: Via effects on blood pressure and lipid metabolism

• Diabetes and metabolic syndrome: Cortisol dysregulation leads to impaired glucose handling

• Osteoporosis: Cortisol suppresses bone-building activity

• Mood disorders: Chronic cortisol imbalance may contribute to anxiety, depression, or mood instability

Two primary clinical patterns are observed:

1. Adrenal Insufficiency (Low Cortisol & DHEA): Linked to fatigue, hypoglycemia, inflammation, and poor recovery

2. Adrenal Stress Response (High Cortisol): Associated with hypervigilance, immune suppression, and metabolic derangement

Understanding the root pattern allows for precise and personalized support strategies.

Causes of Adrenal Dysfunction

The causes of adrenal dysfunction are multifactorial, often rooted in chronic or recurrent stressors. These include:

Psychological and Lifestyle Stressors

• Mental/emotional strain (e.g., anxiety, grief, overwork)

• Poor sleep hygiene

• Excessive exercise without recovery

• Skipping meals or poor dietary balance

• Substance use or alcohol overconsumption

Physiological and Environmental Contributors

• Chronic infections (e.g., Epstein-Barr virus, cytomegalovirus)

• Gut dysbiosis, food sensitivities, or GI inflammation

• Mold exposure and mycotoxins

• Heavy metal toxicity (e.g., mercury, lead, arsenic)

• Nutrient deficiencies (e.g., vitamin C, magnesium, B vitamins)

These factors can overstimulate or exhaust adrenal output over time, eventually leading to hypofunction if unaddressed.

Interfering Factors in Adrenal Assessment

When interpreting adrenal biomarkers, several external variables may alter test results:

• Acute illness or infection may temporarily elevate cortisol

• Oral corticosteroid use suppresses endogenous cortisol production

• Shift work and sleep disruption blunt normal cortisol rhythms

• Stimulants (e.g., caffeine, nicotine) can acutely affect adrenal output

• Timing of sample collection is critical due to diurnal variation

Laboratory data should always be contextualized within the clinical picture.

Drug-Induced Alterations

Some medications can interfere with adrenal biomarker readings or adrenal gland function:

• Increased Adrenal Activity: Caffeine, amphetamines, pseudoephedrine; estrogens (OCPs) may elevate cortisol-binding globulin

• Decreased Adrenal Output: Glucocorticoids (prednisone) suppress ACTH/cortisol; opioids and benzodiazepines reduce ACTH; ketoconazole/metyrapone inhibit cortisol synthesis

Proper documentation of medication history is crucial in adrenal evaluation.

Functional Medicine Approach to Adrenal Dysfunction

At Intercoastal Health, we integrate a functional medicine nurse practitioner approach when addressing adrenal dysfunction. This includes:

• Root cause identification: Addressing sources of chronic stress and toxicity

• Nutrition optimization: Supporting micronutrient status (e.g., B5, C, magnesium, adaptogens)

• Lifestyle adjustments: Improving sleep quality, emotional regulation, and stress resilience

• Targeted supplementation: Based on biomarker findings, using evidence-based nutraceuticals

• Collaborative care: Referrals for psychotherapy, GI workup, or detoxification support as indicated

The goal is to restore healthy adrenal rhythm, optimize energy, and support long-term metabolic health.

Conclusion

In conclusion, a comprehensive evaluation by a functional medicine nurse practitioner in Florida facilitates identification of adrenal dysfunction and its underlying drivers. By integrating evidence-based nutrition, targeted biomarker testing, and supportive therapies such as IV Therapy and Regenerative Medicine—where rapid nutrient delivery and tissue support are paramount—we offer a preventive, regenerative framework to rebuild resilience and optimize wellness. Call (904) 799-2531 or schedule online.

Further Reading

• Bornstein SR, et al. “Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline.” J Clin Endocrinol Metab. 2016;101(2):364–389. https://academic.oup.com/jcem/article/101/2/364/2764826

• Peeke PM, Chrousos GP. “CRH and the Hypothalamic-Pituitary-Adrenal Axis: Role in Obesity and Metabolic Syndrome.” Endocrinol Metab Clin North Am. 2007;36(3):497–515. https://pubmed.ncbi.nlm.nih.gov/17148736/https://doi.org/10.1016/j.ecl.2007.06.012

• Dineen RA, et al. Tissue Glucocorticoid Metabolism in Adrenal Insufficiency: A Prospective Study of Dual-release Hydrocortisone Therapy. J Clin Endocrinol Metab. 2023;108(12):3178–3189.
  https://pubmed.ncbi.nlm.nih.gov/37339332/
• Sonino N, Boscaro M. “Management of Cushing’s Syndrome: A Clinical Review.” J Clin Endocrinol Metab. 2006;91(1):1–8. https://doi.org/10.1210/jhttps://pubmed.ncbi.nlm.nih.gov/15783246/c.2005-1469