This clinical evaluation determines the adrenal glands’ capacity to appropriately adjust their glucocorticoid and mineralocorticoid output in response to physiological stressors. It moves beyond simple snapshot hormone levels to gauge the dynamic responsiveness and reserve of the hypothalamic-pituitary-adrenal (HPA) axis. A flexible adrenal response is crucial for maintaining systemic homeostasis and resilience against chronic stress. Impaired flexibility can manifest as dysregulated cortisol patterns throughout the day, impacting energy and immune function.
Origin
The concept originates from functional and integrative endocrinology, building upon traditional HPA axis testing like the ACTH stimulation test. It incorporates the principles of chronobiology and dynamic physiological testing to assess glandular reserve and diurnal rhythmicity. The term reflects a shift in clinical perspective from merely identifying overt adrenal failure to evaluating subclinical dysfunction and optimal hormonal adaptation.
Mechanism
The assessment typically involves measuring salivary or urinary cortisol and DHEA-S levels at multiple time points across a 24-hour cycle. This provides a detailed curve of hormone secretion, revealing the amplitude and timing of the cortisol awakening response and the diurnal decline. The underlying mechanism being evaluated is the neuroendocrine feedback loop governing the stress response, specifically the adrenal cortex’s ability to modulate steroidogenesis rapidly and efficiently.
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