Causes of Adrenal Insufficiency

by Michael B. Schachter, MD, FACAM

Stress and Adrenal Insufficiency

Excessive stress may contribute to the development of mild adrenal cortex insufficiency--a deficiency of hydrocortisone.  Stress may take many forms.  For example, stress can result from: (1) infections; (2) exposures to toxins; (3) sleep deprivation; (4) nutritional deficiencies; (5) loss of love or emotional support; and many others.  All of these factors can adversely affect adrenal functioning. 

Stress may be either acute or chronic.  The adrenal glands are involved with both types.  The adrenal glands are small structures located above each kidney.  The internal part is called the adrenal medulla.  It secretes adrenaline in response to acute stress and prepares the body for fight or flight.

The adrenal cortex, the outer part of the gland, secretes steroid hormones, such as hydrocortisone, to help the body adapt to chronic stress.  Experimental animals, whose adrenal glands have been surgically removed, live normal life spans as long as they are not stressed.  However, if stress stimulation, such as extreme temperatures, is introduced, they quickly die.  From experiments such as these, scientists have deduced that the adrenal glands are necessary for stress management. 

The name of the disease characterized by the complete loss of adrenal cortex function is Addison's Disease.  Symptoms include severe fatigue, low blood pressure, low blood sugar, dizziness, weakness, depression, anxiety, loss of appetite, weight loss, and increased skin pigmentation.  Our most famous public figure to have this disease was President John F. Kennedy.  Patients with Addison's Disease can lead relatively normal lives by taking physiologic replacement doses of natural hydrocortisone pills.  Addison's Disease, or complete adrenal cortex insufficiency, is described in every textbook of medicine and endocrinology.  What is not mentioned is the common condition of mild adrenal insufficiency.  This condition contributes to a wide range of symptoms and diseases. 

People with mild adrenal insufficiency may suffer from the same symptoms as those with Addison's Disease.  Symptoms can include headaches, muscular aches and pains, joint pains, confusion, impaired memory, low motivation, and many others.  Additionally, such people may suffer from an increased susceptibility to all kinds of infections including those caused by bacteria, viruses, parasites, yeast, and fungi. 

Diseases such as rheumatoid arthritis, other autoimmune disorders, ulcerative colitis, Crohn's Disease, hay fever, asthma and many others are made worse when mild adrenal insufficiency is present and may be helped by correcting this condition.  Mild adrenal insufficiency is aggravated by, but also contributes to, a person's abuse of substances, such as alcohol, tobacco, caffeine, recreational drugs, sugar, and artificial sweeteners.

Diagnosis and Treatment

How can mild adrenal insufficiency be diagnosed?  One method is the ACTH stimulation test.  A fasting level of hydrocortisone is taken in the morning.  Then the patient is given an injection of a derivative of ACTH, the pituitary hormone that stimulates the adrenal cortex.  An hour later, another blood sample is taken to check the level of hydrocortisone.  Normally, the hydrocortisone level should double.  If it doesn't, this would indicate relative adrenal insufficiency.  However, sometimes patients may benefit from treatment of this condition, even when the test is normal.

How can relative adrenal cortical insufficiency be treated?  First, whenever possible, we correct underlying causes, such as infections, toxic exposures, poor nutrition, and psychosocial stresses.  Next, the adrenals should be nourished.  This can be done with nutritional support using specific supplements.  The most important supplements for adrenal support are: vitamin C, pantothenic acid, vitamin B6, manganese, magnesium, and raw adrenal tissue.

The New York physician, Dr. John Tintera introduced the concept of mild adrenal cortical insufficiency in the 1940's and 50's.  He used adrenal cortical extract (ACE) injections to rest the adrenals and allow recovery.  He successfully treated functional hypoglycemia, alcoholism, allergies and many other conditions with this treatment.

Since the 1950's and quite independently, Dr. William Mck. Jeffries has been advocating the use of low, oral doses of hydrocortisone to treat mild adrenal insufficiency and related conditions.  In his book Safe Uses of Cortisone, Jeffries recommends half the maintenance dose used for Addison's Disease, namely 5 mg four times a day. With increased stress or infection, the dosage is doubled for a short time. 

Some of the conditions helped by this therapy are: chronic fatigue, frequent infections, asthma, allergies, rheumatoid arthritis, acne, excessive hair growth in young women, infertility, thyroid problems, autoimmune disorders, functional hypoglycemia, ulcerative colitis and many others.  He points out that this therapy, even when given for long periods of time, does not cause any of the side effects and problems associated with the use of high doses or even low doses of synthetic steroids, such as prednisone or decadron.  Low dose hydrocortisone also does not suppress normal adrenal function when used in this way.  This approach offers hope to many patients who have not been helped by any other treatment method.

I treat relative adrenal insufficiency using the nutritional approach and safe, low doses of hydrocortisone.  Both of these therapies have been almost totally ignored by the medical profession.

References

Jeffries, William McK., Safe Uses of Cortisone (Springfield: CC Thomas, 1981)