No hormone in the body can work optimally on its own. It’s common in today’s medical mindset to try to isolate a problem by only looking at where there is dysfunction and not take into account how an organ will be influenced by another organ and in turn, influence others.
Take, for example, you’re sitting at the airport in Atlanta waiting for your plane but it’s delayed several hours due to a storm at its departure airport in Detroit. Though the storm is hundreds of miles away it’s affecting you even though the problem isn’t in Atlanta. Conventional methods will look to fix the problem in Atlanta rather than see if it’s a result of something or somewhere else. The same process happens often in our bodies with one system affecting another which in turn has an effect somewhere else. Let’s look at some common examples.
Blood Sugar and the Adrenals
The adrenal glands work with the pancreas to balance and regulate blood sugar. When you eat some carbohydrates (sugar), insulin from the pancreas helps to lower blood glucose levels. Yet when you need more sugar in your blood stream, it’s the adrenals responsibility to secrete epinephrine or cortisol to either release some stored sugar (glycogen) or make it from some protein (amino acids). Many people feel like their blood sugar is dropping and they’re hypoglycemic yet when they stick themselves to get a drop of blood to test their glucose level, it’s perfectly normal. This is often due to a high cortisol level which is impairing that glucose from getting into the tissues. If you crave sugar then be assured that your adrenal glands are fatigued; it’s a sign that your adrenal-pancreas balance is not functioning optimally.
Thyroid Problems and the Adrenals
Thyroid gland problems are one of the most common endocrine disorders of present day. They’re as much of a diagnosed health problem today as pancreas problems (diabetes). The interaction of the thyroid and adrenals is very unique and very important to maintain health. When the adrenal glands are chronically stressed, eventually the thyroid hormone levels begin to drop and soon the person is told they have hypothyroidism and they need to go on a medication such as Synthroid. And if the adrenal glands are very fatigued, the thyroid may secrete more hormone to help provide the body with energy, resulting in a temporary hyperthyroid problem. Also, cortisol blocks the conversion of thyroid hormone T4 to T3, which can result in the body making more T4 and eventually lead to a thyroid disorder. Many people on thyroid meds continue to suffer from adrenal gland problems yet they constantly feel the need to increase their thyroid medication to give them sufficient energy where in reality they should be dealing with the adrenal issue.
Sex Hormones, Pregnancy, and the Adrenals
DHEA, which is secreted by the adrenal glands, (as well as around 5% by the testes/ovaries too), is the most abundant steroid hormone our body makes. DHEA further converts primarily into testosterone in men and estrogen in women. If the adrenals are not functioning well then sex hormone production will eventually be influenced as there is not enough DHEA to make the hormones. Yet, there is often a greater problem of high cortisol levels robbing the necessary building blocks of these hormones as a person uses many of those same substrates (vitamins and minerals) to make the cortisol to deal with the stress that they also need to make DHEA, estrogen, progesterone, and testosterone.
So if a man is under too much stress then his body will use up the precursors necessary for testosterone to now make cortisol, and subsequently DHEA and testosterone levels will fall. In a woman, a similar situation will happen with estrogen (from DHEA) but even more with progesterone which can not only result in health and sexual problems but also pregnancy issues too. Essentially rather than produce sufficient progesterone she’ll make cortisol to deal with the stress problems in her life.
During the menstrual years, about one-third of a woman’s testosterone comes from her adrenal glands, (the other two-thirds is from the ovaries). In menopause, her progesterone and testosterone levels will be determined by sufficient adrenal gland output. The adrenals, along with the liver and fatty tissue, should also provide a woman with sufficient estrogen levels during menopause. Unfortunately many women’s adrenal glands are functioning so poorly that they cannot make the proper amounts of hormones to keep her healthy during those years.
In the follicular (preovulatory) phase of a woman’s cycle, the progesterone primarily comes from the adrenal glands, not the ovaries (they provide progesterone during the second half of the cycle – the luteal phase). Therefore, if the adrenal glands are not functioning properly then a woman can suffer symptoms of low libido, ovulation problems, and especially PMS. Furthermore, a woman with adrenal gland problems suffering from sub-optimal progesterone levels will often have trouble getting pregnant and she is also at risk of a first trimester miscarriage as sufficient progesterone levels are of utmost importance during this time. Unfortunately, most OBGYN doctors do not realize the importance of the adrenal glands when investigating pregnancy or conception complications.
A fetus’s adrenal glands are developing during the third trimester and if the mother has suffered from excessive stress and her adrenal gland function is hindered, then she can begin to draw from the baby’s hormonal levels. This will result in the mother feeling physically and mentally great in the third trimester, (often better than the first two trimesters). But unfortunately the story does not often end well as it’s a main reason for postpartum depression for the mom, (she no longer has those adrenal reserves once the baby is born), and the newborn is now left with fatigued adrenal glands which often manifests itself with health problems such as allergies and asthma.
Sleep, the Pineal Gland, and the Adrenals
The pineal gland sits deep in the center of the brain and produces melatonin, which regulates our sleep-wake cycle. Much like the circadian rhythm of the adrenal glands, the level of melatonin normally fluctuates during a 24-hour period. Melatonin levels should be highest at night, opposite those of cortisol, and lowest in the morning, when cortisol rises to its highest level of the day.
Abnormal melatonin-cortisol rhythms result in problems with sleep. Often with insomnia, cortisol levels are much higher than what they should be at that time of the night, and their suppression of melatonin results in the person being unable to fall asleep. Spikes in cortisol and/or epinephrine in the middle of the night, often as a result of blood sugar dysregulation, will cause the person to wake up and perhaps unable to get back to sleep depending on the severity of the hormonal spike.
The Heart, Blood Pressure, and the Adrenals
As mentioned previously, the hormone aldosterone secreted by the adrenal glands has a major effect on the blood pressure as well as the function of the entire cardiovascular system. An imbalance of electrolytes, regulated by the adrenal glands, can result in an abnormal heart rhythm, often either a racing heart rate or heart beat palpitations which many describe as a “flip-flop”. This is often due to an imbalance of sodium and potassium levels in the body, which can be due to poor adrenal gland function. Of course it’s wise to always have any heart problem checked out by your physician.
Many blood pressure medications directly impact these electrolyte levels. HCTZ is a common blood pressure med that acts as a diuretic, lowering potassium levels. ACE inhibitor medications such as Lisinopril effectively lower aldosterone levels and therefore decrease sodium levels which in turn lower blood pressure. Many high blood pressure patients are unfortunately prescribed multiple medications as a shot-gun approach; they’re taking diuretics which deplete potassium, ACE inhibitors which deplete sodium, and even calcium channel blockers which displace calcium. Chronic electrolyte depletion, especially over time, can result in many health problems ranging from fatigue, to muscle cramps and joint pain, to even cardiovascular problems which they were prescribed to initially prevent. Of course this is does not mean you should stop or alter your medication without the advice of your prescribing physician. But it does mean that you should be informed about your health and the effects of medications on your health, both positive as well as negative.
In the fourth and final part of this adrenal gland series, I discuss steps you can take to recover from adrenal gland dysfunction or fatigue. After all, knowing that your adrenal glands are not working well means does you no good if you don’t know how to correct the problem!
Lorraine says
I know my adrenals are not up to par and have the strangest hip, inner thigh, knee and calf issues happening! I am sooo anxious to see the next article!
Lorraine says
Would like to read Part I but cannot find it…
drgangemi says
Just go to the home page and scroll down a few.
MJ says
Will be very interested in next article. Will it also discuss the various testing options?
I am 47 yo female, distance runner, w/o a thyroid due to surgery for thyroid cancer following some yrs of Hashimoto’s & being on low level of replacement. So I’m on thy meds (T4 & T3) as well as oral contraceptives, PPI & other meds for GERD/ulcers/hiatal hernia, have many food intolerances, probably in perimenopause also (such fun). In a recent heavy training period, lost weight and fat (more than seemed called for as wasn’t trying to lose and was being careful about eating enough – eat Paleo), doc said my testosterone is low and in past (didn’t test recently) cortisol was ok but DHEA was low. Suspect estrogen not right also, but perimeno fluctuations throwing that off.
Will be very interested in how one isolates that the problem is adrenals given all the systemic interactions. Also relationships to sleep, energy, training performance and recovery are of huge interest to me. It seems almost impossible to balance and feel well with so many systems and constant change!
One note – I had several months of strong hypoadrenal symptoms (orthostatic hypotension, salt cravings, exhaustion, etc) a few years ago and figured out it was because I had stopped the nasal corticosteroid spray (flonase, nasonex) that I’d been on for many years – it was basically withdrawal, from what I understand. It seemed to resolve on its own but was kinda scary. Sharing that in case it helps someone else.
Thanks for writing these columns.
Raffy says
I just wanted to say….great articles so far! Thanks!
Jan says
Thank you very much for taking the time to write such a comprehensive explanation of all this. Fascinating and at the same time, scary considering our increasingly stressful society.
Roland says
I am confused by your explanation of blood sugars and the adrenals. You say it is the, “adrenals responsibility to secrete epinephrine or cortisol to …release some stored sugar”. A few sentences later you say, “high cortisol level(s)…impair glucose from getting into the tissues”. I gather the distinguishing word here is “high”. Could you explain how and at what point cortisol goes from being a benefit to being a problem?
drgangemi says
Basically too much is bad thing. Chronically high levels of stress hormones inhibit proper glucose absorption.
Danyia says
This was so informative! I read all four. I am a 34 yr female, that has various things going on, and have been looking into a possible tumor on my pituitary gland. I have type 1 diabetes, diagnosed at 30. Didn’t fit the profile at all, doctors were stunned. Then started having adrenal storms ( during my periods ) where my BP would jump up and drops and I get shaky, and it lasts for a couple days. Have been bedridden for a few years, and am trying to get to the bottom of this. Any Ideas? The more I read about the adrenal gland the more I am wondering if this all fits together? BP and my periods, and diabetes?
Kimberly says
love finding your articles on adrenals ……not many know about this !! Very hard to find a dr. who does. What do you do to treat adrenals?
I am 50, have had insomnia for a year now, and my saliva tests were slightly low estrogen last Aug. Ive had slightly high blood pressure, HAD plantar
fasciitis, (healed most of it by going off carbs) but if im on my feet too much, i get pain and shoots up the outside of my right leg. also righ breast pain. (not sure if that is related or just hormonal). Still have cycles ever 25 days. I also have woken up at 4:30am every morning for over a year. sometimes at 2, 3, etc. I know my blood sugar is involved. i have energy and never have had low energy. so I want to know what to do to heal this? I want to be normal and sleep again and stop living on Unisom!! :( Thanks!!
Jared says
Thank you Dr. Gangemi for the excellent article and education! Your site is very informative and helpful.
Linda says
Up ’til this year, my 78th, I’ve had very good health. Still working. Now every thing is dysregulated and out of whack. I feel I have completely lost my former self. After reading this series on the adrenals, this details a lot of my current suffering. Chronic Adrenal surges with all the trimmings along with balance and vestibular (POTS) issues. Thanks for putting it all together in a way no allopathic doctor has seen (or heard?). Eating well and doing gentle balance, stretching and core exercise on a chair with some standing. Determined to get some of my former thriving self back.