Adrenal Stress

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

Adrenal stress is a physiological and biochemical response to internal or external stressors, manifesting as sustained activation of the body’s stress response systems. In a functional medicine nurse practitioner framework, adrenal stress is understood not as a single disease, but as a progressive spectrum—ranging from early hyperfunction to later hypofunction or insufficiency. At Intercoastal Health, we use advanced biomarker testing and personalized protocols to identify adrenal hyperfunction and mitigate its systemic impact before it evolves into deeper endocrine imbalance.

Background: The Body’s Response to Stress

Stress is any stimulus—physical, emotional, or environmental—that challenges the body’s homeostasis. The human stress response evolved to handle acute threats with short-term activation of the sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis. During acute stress, catecholamines (epinephrine and norepinephrine) are released from the adrenal medulla, while the adrenal cortex produces cortisol, a hormone critical for energy mobilization and immune regulation.
In modern life, however, stress is often chronic and multifaceted. Unlike transient threats, prolonged stress does not resolve quickly. This persistent exposure can result in sustained activation of the adrenal glands, with downstream effects on metabolic, immune, cardiovascular, and endocrine systems. The term “adrenal hyperfunction” refers to this compensatory phase, where cortisol remains elevated relative to DHEA-S and the stress axis loses sensitivity to normal negative feedback mechanisms.

Clinical Features: Signs and Symptoms of Adrenal Hyperfunction

The hyperfunction stage of adrenal stress is characterized by excessive production of cortisol in response to chronic stressors, without a corresponding rise in DHEA. This imbalance leads to a wide array of clinical signs and symptoms that may initially be subtle but often become increasingly disruptive.
Common Signs and Symptoms Include:

Metabolic Dysfunction:

• Increased insulin resistance

• Elevated blood glucose

• Central adiposity (weight gain around the abdomen)

• Increased LDL cholesterol

• Reduced protein synthesis and muscle wasting

Immune Impairment:

• Chronic or recurrent viral infection (e.g., EBV, CMV)

• Decreased lymphocyte activity

• Low secretory IgA and compromised mucosal immunity

• Heightened allergy response

Musculoskeletal Effects:

• Increased gluconeogenesis leading to catabolism of muscle

• Accelerated bone loss (Bone Health)

Neuropsychiatric and Hormonal Symptoms:

• Insomnia

• Anxiety, restlessness, or feeling “keyed up”

• Clenching or grinding of teeth

• Hunger and food cravings

• Premenstrual syndrome or other hormonal disturbances

• Headaches and hot flashes

Cardiovascular Concerns:

• Elevated blood pressure

• Salt and water retention due to aldosterone excess

Dermatologic and Endocrine Signs:

• Hirsutism (excess facial/body hair in females)

• Reduced vitality and recovery

These symptoms may vary depending on an individual’s genetics, nutritional status, lifestyle habits, and the chronicity of stress exposure.

Diagnostic Evaluation: Beyond a Single Test

Adrenal hyperfunction is not reliably diagnosed through a single laboratory test. Instead, a comprehensive approach integrating biomarkers, patient history, and symptom patterns is recommended.
Diagnostic Tools Include:

• Salivary Cortisol Testing: Measures cortisol levels at multiple intervals throughout the day to evaluate diurnal rhythm. A flat or elevated curve with low DHEA may indicate hyperfunction.

• DHEA Levels: Assesses adrenal androgen reserve. When DHEA remains low or static in the face of rising cortisol, the cortisol/DHEA ratio becomes unfavorable.

• ACTH Levels: May remain elevated due to impaired negative feedback from cortisol.

• Comprehensive Symptom Review: Identifies patterns consistent with chronic stress physiology.

• Additional Labs: May include metabolic panels, thyroid function, insulin–fasting, inflammatory markers (e.g., C-Reactive Protein), and lipid profiles to assess systemic impact.

The cortisol/DHEA ratio is a particularly useful marker, as it reflects the balance between catabolic (cortisol) and anabolic (DHEA) activity.

Etiology: Common Causes of Adrenal Stress

Adrenal hyperfunction arises not from a singular cause, but from a cumulative burden of stressors over time. The body’s ability to adapt becomes compromised, resulting in endocrine dysregulation.
Key Contributing Factors:

• Psychological Stress: Chronic anxiety, occupational strain, unresolved trauma, or grief

• Sleep Disruption: Inadequate or poor-quality sleep disrupts cortisol rhythms

• Dietary Imbalance: High sugar intake, nutrient deficiencies (B-vitamins, magnesium, vitamin C), and irregular meals

• Physical Stress: Overtraining, chronic pain, or illness without sufficient recovery

• Environmental Stressors: Heavy metals, mold exposure, mycotoxins, BPA

• Inflammatory and Infectious Conditions: Gut dysbiosis, hidden viral or bacterial infections, autoimmunity

Left unaddressed, these stressors can impair cortisol regulation and lead to compensatory adrenal overactivity.

Interfering Factors in Adrenal Testing

A number of variables can influence adrenal biomarker results, making context and timing essential for proper interpretation.
Interfering Factors Include:

• Time of Day: Cortisol’s diurnal peak in the morning and trough at night

• Acute Stress: Short-term illness or emotional events

• Stimulant Use: Caffeine, nicotine, certain medications

• Hormonal Medications: Estrogen therapy raising cortisol-binding globulin

• Shift Work: Alters circadian rhythm

• Undiagnosed Infections or Inflammation: Sustained immune stress

Clinicians must evaluate laboratory results alongside clinical history and lifestyle patterns to avoid misdiagnosis.

Medication Effects on Adrenal Function

Several commonly prescribed or over-the-counter medications can influence adrenal hormone levels or alter test results.
Medications That May Increase Cortisol or Mimic Stress Response:

• Stimulants (amphetamines, pseudoephedrine)

• Oral contraceptives or estrogen therapy

• SSRIs and other antidepressants

Medications That May Suppress Adrenal Output:

• Chronic corticosteroid use (prednisone, dexamethasone)

• Ketoconazole and similar antifungals

• Opioids

Medication review is essential to avoid overlooking drug-induced dysregulation.

Associated Conditions

Adrenal hyperfunction may contribute to or exacerbate several clinical conditions.
Commonly Linked Conditions:

• Metabolic Syndrome

• Thyroid Function

• Reproductive Hormone Function

• Mental Health Disorders (anxiety, depression)

• Chronic Fatigue Syndrome / Fibromyalgia overlap with adrenal dysfunction

• Cushing’s Syndrome (end-stage hyperfunction)

Identifying adrenal stress early may prevent progression toward more advanced endocrine disorders.

Functional Medicine Treatment Approach

At Intercoastal Health, our treatment for adrenal hyperfunction is rooted in identifying the causes of stress, supporting resilience, and restoring hormonal equilibrium. Interventions are tailored based on individual biomarker trends and clinical presentation.
Key Strategies May Include:

• Lifestyle Adjustments: Sleep prioritization, stress management, limiting evening screen time

• Nutrition & Supplementation: Balanced macronutrients, B-complex, vitamin C, magnesium, adaptogens

• Mind-Body Therapies: Breathwork, meditation, yoga, cognitive behavioral therapy

• Gradual Physical Activity: Low-intensity movement, avoiding overtraining

• Ongoing Monitoring: Repeat biomarker testing every 3–6 months and adjust protocols

Functional support during adrenal hyperfunction can prevent downstream hypofunction or complete adrenal burnout.

Further Reading

• Nieman LK, et al. “The Diagnosis and Treatment 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

• Tsigos C, Chrousos GP. “Hypothalamic–Pituitary–Adrenal Axis, Neuroendocrine Factors and Stress.” J Psychosom Res. 2002;53(4):865–871. https://doi.org/10.1016/S0022-3999(02)00429-4

• McEwen BS. “Stress, Adaptation, and Disease: Allostasis and Allostatic Load.” Ann N Y Acad Sci. 1998;840:33–44. https://doi.org/10.1111/j.1749-6632.1998.tb09546.x

Conclusion
Early identification of adrenal hyperfunction through a functional medicine practitioner model enables us to restore balance and resilience. By integrating targeted IV Therapy and Regenerative Medicine—where precise nutrient delivery and cellular repair support accelerate recovery—we empower patients to rebuild vitality, optimize endocrine health, and prevent deeper adrenal deficits. Call (904) 799-2531 or schedule online.