Adrenal Insufficiency

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

Adrenal insufficiency, also referred to as adrenal hypofunction or “adrenal fatigue,” represents a state of diminished adrenal gland performance often resulting from prolonged exposure to physical, emotional, or environmental stressors. At Intercoastal Health, we take a functional medicine telehealth approach to evaluating and addressing adrenal insufficiency by identifying the root causes, interpreting biomarker trends, and supporting recovery through evidence-informed care.

Background: What Is Adrenal Insufficiency?

The adrenal glands play a vital role in stress response, hormone regulation, and metabolic balance. Adrenal insufficiency develops when these glands can no longer produce adequate levels of hormones such as cortisol and DHEA despite ongoing stimulation by adrenocorticotropic hormone (ACTH).
This condition typically arises in the later stages of adrenal decompensation. Initially, the body responds to stress by increasing sympathetic activity and releasing catecholamines. Over time, continued activation of the hypothalamic-pituitary-adrenal (HPA) axis causes persistent elevation of ACTH. Eventually, the adrenal cortex becomes unresponsive, leading to a dramatic reduction in cortisol production, and often, a concurrent decline in DHEA levels.

Clinical Signs and Symptoms of Adrenal Hypofunction

Adrenal insufficiency is often underdiagnosed due to its non-specific symptoms. However, when viewed through a functional medicine lens, the symptom patterns provide valuable insights into endocrine and metabolic imbalances.
Common Symptoms Include:

• Fatigue and low energy

• Reactive hypoglycemia (hunger and mood shifts between meals due to glucose instability)

• Low blood pressure or dizziness

• Salt cravings

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

• Menstrual irregularities and PMS

• Chronic allergies

• Alcohol intolerance

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

• Prolonged recovery from illness

Clinical Features of Adrenal Hyperfunction

The early “hyperfunction” phase involves excessive cortisol relative to DHEA, leading to:

• Increased insulin resistance

• Elevated blood sugar

• Central adiposity (abdominal weight gain)

• Increased LDL cholesterol

• Immune suppression (e.g., recurrent infections)

• Muscle wasting and accelerated bone loss

• Insomnia, anxiety, and emotional instability

• Headaches and hot flashes

Biomarker Assessment and Diagnostic Workup

Functional evaluation includes both laboratory testing and biomarker interpretation:

• Morning Serum Cortisol: Measured between 7–9 a.m.; low levels suggest insufficiency

• DHEA-S: Low levels reflect chronic adrenal compromise

• Aldosterone: Evaluates mineralocorticoid output

• Sodium/Potassium Ratio: Indicates aldosterone activity

• Chloride: Offers insight into fluid and acid-base balance

Additional tools include ACTH stimulation testing, insulin-induced hypoglycemia, metabolic panels, thyroid function, and inflammatory markers to obtain a comprehensive view.

Etiology: Root Causes of Adrenal Hypofunction

Common contributors include:

• Chronic psychological stress

• Nutritional deficiencies (B5, vitamin C, magnesium)

• Poor sleep habits

• Overtraining without recovery

• Hypoglycemia and sugar swings

• Allergies and chronic inflammation

• GI dysfunction and dysbiosis

• Toxin exposure (heavy metals, molds)

• Persistent viral infections

Interfering Factors in Assessment

Proper interpretation requires context:

• Timing relative to diurnal cortisol rhythm

• Acute illness or injury

• Exogenous steroid use

• Shift work and circadian disruption

• Caffeine, nicotine, and other stimulants

• Hormonal contraceptives

Medication Effects on Adrenal Function

Medications can alter readings or function:

• Suppressors: Glucocorticoids, opioids, ketoconazole

• Distorters: Oral estrogens, stimulants, antidepressants

A detailed medication history is vital for accurate evaluation.

Functional Medicine Management at Intercoastal Health

Our tailored strategy includes:

• Comprehensive Biomarker Testing to track hormone trends

• Nutrition & Supplementation: B-complex, magnesium, adaptogens

• Lifestyle Adjustments: Restorative sleep, stress management

• Mind-Body Therapies: Meditation, breathwork

• Gradual Physical Activity: Avoid overtraining

• Ongoing Monitoring: Repeat testing every 3–6 months

Conclusion

Early identification of adrenal insufficiency through a functional medicine telehealth approach allows us to restore hormone balance and resilience. By combining targeted IV Therapy and Peptide Therapy—where precise nutrient delivery and cellular signaling support accelerate recovery—we offer patients a regenerative framework to rebuild vitality, optimize endocrine health, and prevent deeper adrenal deficits. Call (904) 799-2531 or schedule online.

Further Reading

• • Nieman LK, et al. “The Diagnosis and Clinical Management of Primary Adrenal Insufficiency.” J Clin Endocrinol Metab. 2021;106(4):1051–1064. https://academic.oup.com/jcem/article/106/4/1051/6136425

  • 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://doi.org/10.1210/jc.2015-1710

  • El-Farhan N, Rees DA, Evans C. “Measuring Cortisol in Serum, Urine and Saliva—Are Our Assays Good Enough?” Ann Clin Biochem. 2017;54(3):308–322. https://doi.org/10.1177/0004563216672071

  • Stewart PM, Stewart BJ. “Glucocorticoid Excess.” Lancet. 2018;392(10152):1958–1970. https://doi.org/10.1016/S0140-6736(18)32225-8