This term clinically describes a pattern of non-Addisonian symptoms, such as persistent fatigue, body aches, and sleep disturbance, often attributed to chronic stress leading to dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The profile is characterized by specific, measurable deviations in the diurnal rhythm and total output of adrenal hormones, primarily cortisol and DHEA. It represents a state of chronic physiological adaptation and eventual maladaptation to sustained allostatic load. This profile reflects the body’s attempt to conserve energy under duress.
Origin
While “adrenal fatigue” is a popular term in wellness circles, the underlying physiological concept originates from endocrinology’s understanding of the stress response system, specifically the HPA axis. Clinical endocrinology recognizes HPA axis dysregulation, often referring to it as non-specific stress-related illness or subclinical adrenal insufficiency, distinct from the recognized pathology of Addison’s disease. The profile is an attempt to categorize the biochemical and symptomatic manifestations of this chronic stress response.
Mechanism
The profile is mechanistically driven by sustained over-activation of the HPA axis due to chronic psychological or physiological stressors. Initial hypercortisolism may transition into a pattern of blunted or erratic cortisol secretion throughout the day, often seen in the later stages of HPA axis dysregulation. This altered feedback loop sensitivity impacts the pulsatile release of CRH and ACTH, ultimately compromising the adrenal gland’s ability to maintain optimal glucocorticoid and mineralocorticoid levels, which are vital for energy and homeostasis.
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