How does hypocorticism affect fat metabolism

Cortisol deficiency

Important NOTE:

If you would like a diagnostic clarification, please contact the stress clinic at the Stress Center Trier directly. Neuropattern diagnostics are no longer offered in the practice for psychotherapy in Munich.

The tasks of the stress hormone cortisol

With the help of the hormone cortisol, the organism adjusts to acute and chronic stress. Cortisol is therefore also a "stress hormone". Cortisol is produced in the adrenal cortex. Production is controlled by the ACTH hormone. ACTH is released in the brain in a certain daily rhythm and depending on the upcoming loads. The release of cortisol aims to provide quickly available energy in times of stress.

Cortisol leads to the following physical and psychological changes:

  • Increase in blood pressure
  • Increase in blood sugar
  • Increase in blood lipids
  • Anti-inflammatory
  • Suppression of the immune system
  • Elevated mood, mood swings, dissatisfaction, irritability, anger

The excretion of cortisol leads to a physical and psychological activation in order to optimally prepare the organism for an upcoming challenge or a fight. The preparation for a fight goes so far that cortisol even increases the coagulation of the blood to prevent bleeding to death in the context of a possible injury.

From excess cortisol to relative lack of cortisol

As can be seen from the symptoms listed, the stress reaction mediated by cortisol is actually an acute reaction to ensure survival. Acute means that a short-term stress such as an attack quickly ceases and the organism can then "switch" back to the recovery mode. The stress reaction becomes problematic if it is not ended again soon and is repeated daily. With constant repetition, the release of cortisol increases more and more and from a certain point the organism is no longer able to “switch” to the recovery mode. Then there is restlessness, activism, inability to relax, and irritability and mood swings. In the event of permanent overactivation, the performance of the adrenal cortex can at some point be reduced or exhausted, resulting in less cortisol being released and a relative cortisol deficiency. In certain diseases, the adrenal gland can cease to function completely (Addison's disease).

How do you recognize a cortisol deficiency?

A lack of cortisol can lead to the following symptoms:

  • exhaustion
  • Feeling weak
  • Daytime sleepiness
  • Gastrointestinal complaints
  • Low blood pressure
  • Low blood sugar
  • Hunger for salt

However, the symptoms are quite general, which is why the diagnosis must be made using a laboratory test.

How do you diagnose a cortisol deficiency?

An absolute cortisol deficiency in the sense of Addison's disease is diagnosed on the basis of the symptoms and evidence of typical laboratory changes. In the case of Addison's disease, there is a significantly increased ACTH and a significantly reduced cortisol in the blood. For a reliable diagnosis, it is best to contact an internal medicine specialist specializing in endocrinology.

The diagnosis of a relative cortisol deficiency is extremely demanding for various reasons and the clinical picture is also not generally recognized. The generally recognized clinical picture of Addison's disease describes an extreme condition. Virtually no cortisol is produced here. But there are also people who do not have Mobus Addison, but still - compared to healthy people - have a reduced production of cortisol. These people are in a medical gray area, so to speak. In the USA, such a condition is often referred to as "adrenal fatigue". However, a “comparatively” lower production of cortisol is extremely difficult to detect. The determination of cortisol in the blood is not suitable for detection here as it is only a “snapshot”. On the one hand, due to the circadian rhythm in the course of the day, there are considerable differences in the detectable cortisol concentration. On the other hand, cortisol production is also heavily dependent on the stresses of the day. For this reason, the determination of individual values ​​for the detection of a relative cortisol deficiency is not suitable. In order to get a meaningful measurement result, cortisol must be determined several times a day over several days using the right technique. A determination in saliva is best suited for this. In addition, to demonstrate a relative cortisol deficiency, the interpretation of the measured values ​​must not be based on the extreme values ​​of Addison's disease, but values ​​that relate to the comparison with symptom-free people. In addition, it makes sense not only to measure the cortisol value, but also to check the function of the cortisol control circuit (dexamethasone inhibition test).

Proof of a relative cortisol deficiency is therefore extremely challenging. The best detection method was developed by Prof. Hellhammer in Trier. As part of the neuropattern diagnosis, the cortisol values ​​are determined several times a day over three days. In the evening of the second day, 0.25 mg dexamethasone is taken and on the third day the cortisol awakening reaction is measured again (dexamethasone inhibition test). Prof. Hellhammer has also developed his own limit values ​​by making a comparison with a healthy comparison group.

In the practice in Munich, numerous measurements were carried out with the help of neuropatterns between 2014 and 2019 together with Prof. Hellhammer. Unfortunately, Prof. Hellhammer passed away in 2019. The neuropattern diagnosis was then discontinued in the practice. The Trier Stress Center still offers the measurement and the test materials can be ordered there. A basic stress profile and a premium stress profile are offered there. With the basic stress profile, the cortisol awakening reaction is only determined on two days. The premium stress profile corresponds to the earlier neuropattern diagnostics. Here even more cortisol levels are determined during the day and a dexamethasone test is carried out on the third day. In addition, the heart rate variability is measured overnight and a questionnaire diagnosis is carried out. To demonstrate a relative cortisol deficiency, more extensive testing using the Premium stress profile or neuropattern is recommended. When evaluating the cortisol values, the standard values ​​developed by Prof. Hellhammer over decades are used as a basis. The examinations will also be evaluated in Trier and you will receive a corresponding treatment recommendation.

How do you treat a relative cortisol deficiency?

The treatment recommendation for neuropattern diagnostics depends on the severity of the relative cortisol deficiency. In mild cases, an attempt can be made to reactivate cortisol production through exercise and diet. In addition, in the case of mild to moderate deficiency states, the administration of certain herbal preparations that stimulate cortisol production can be useful. In the case of a pronounced relative cortisol deficiency, certain drugs can be useful, which lead or contribute to a normalization of cortisol production. For short-term stress reduction, behavioral therapeutic measures are usually recommended. In the long term, the best way to reduce stress levels is through psychodynamic psychotherapy or psychodynamic coaching.

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Keywords:Adrenal fatigue, cortisol deficiency, neuropatterns