Endocrine System Triage is a clinical concept describing the adaptive, hierarchical prioritization of hormone production and allocation by the body, particularly under conditions of chronic stress or resource scarcity. The body strategically shunts metabolic precursors toward the synthesis of survival-critical hormones, most notably cortisol, at the expense of non-essential hormones like sex steroids and thyroid hormone. This survival mechanism, while acutely beneficial, can lead to long-term deficiencies in reproductive, metabolic, and anabolic functions.
Origin
The term is a metaphorical application of the medical concept of “triage,” derived from the French verb trier, meaning “to sort,” used to prioritize treatment based on severity and prognosis. In endocrinology, it illustrates the adrenal gland’s dominance under stress and the subsequent down-regulation of the thyroid and gonadal axes. This functional prioritization highlights the body’s deeply ingrained survival imperative.
Mechanism
The triage mechanism is largely driven by the Hypothalamic-Pituitary-Adrenal (HPA) axis and the availability of cholesterol, the universal steroid precursor. Chronic HPA axis activation demands high cortisol output, which utilizes a disproportionate share of available pregnenolone, a phenomenon often termed “pregnenolone steal.” This resource diversion reduces the substrate pool for DHEA, testosterone, and estrogen synthesis, functionally conserving energy for immediate survival while sacrificing long-term vitality and reproductive fitness.
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