A clinical evaluation designed to assess the functional capacity of the hypothalamic-pituitary-adrenal (HPA) axis, specifically focusing on cortisol and DHEA output patterns over a diurnal cycle. This assessment seeks to identify dysregulation in the body’s primary stress response system, which is often clinically referred to as adrenal fatigue or HPA axis dysfunction. The objective is to map the physiological response to chronic stressors rather than diagnose a specific adrenal pathology like Addison’s disease. Accurate interpretation guides targeted support strategies for endocrine balance.
Origin
The concept originates from early functional medicine interpretations of chronic stress impact on the adrenal glands, moving beyond strict endocrinological disease models. Etymologically, ‘adrenal’ refers to the glands situated atop the kidneys, while ‘fatigue’ implies a diminished functional output capacity rather than structural failure. This term evolved to describe a spectrum of symptoms related to sustained allostatic load affecting glucocorticoid and mineralocorticoid production. It is a practical term used clinically to describe subclinical HPA axis imbalance.
Mechanism
The assessment typically employs saliva or dried urine samples collected at timed intervals throughout the day to profile hormone secretion kinetics. This method captures the natural pulsatile release of cortisol, providing insight into the axis’s ability to respond robustly to morning signals and wind down appropriately in the evening. Analyzing these curves helps correlate subjective patient symptoms with objective endocrinological data points. Through this process, we can discern patterns indicative of HPA axis hypo- or hyper-reactivity.
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