Hompes MethodPractitioner Training Level II

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Lesson Thirty-one – The Adrenals

Stress and the Adrenals

• In lesson 30 we explored the concept of physiological stress. The diagram on the right does a great job of illustrating it (taken from Dr. Wilson’s book, Adrenal Fatigue.

Stress and the Adrenals

• In this lesson we’re going to explore what actually happens when the body switches on its stress / fight or flight response, paying special attention to the adrenal glands.

Adrenal Anatomy

http://endocrine101.wikispaces.com/Adrenal+

Cortex+Factshttp://en.wikipedia.org/wiki/Adrenal_glands

Adrenal Anatomy

• The adrenal cortex is responsible for the production of several steroid hormones (steroid simply means “made from cholesterol”).

• The adrenal medulla is responsible for the production of the catecholamines – adrenaline and noradrenaline (also known as epinephrine and norepinephrine).

The HPA Axis

• The Hypothalamic > Pituitary > Adrenal axis is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland (a pea-shaped structure located below the hypothalamus), and the adrenal glands.

Hypothalamus

• The hypothalamus is a portion of the brain that contains a number of small nucle with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland. The hypothalamus is roughly the size of an almond.

Hypothalamus

http://en.wikipedia.org/wiki/Hypothalamus

Hypothalamus

• The hypothalamus is responsible for certain metabolic processes and other activities of the autonomic nervous system. It synthesizes and secretes certain neurohormones, often called releasing hormones or hypothalamic hormones, and these in turn stimulate or inhibit the secretion of pituitary hormones.

Hypothalamus

• The hypothalamus controls body temperature, hunger, important aspects of parenting and attachment behaviors, thirst, fatigue, sleep, and circadian rhythms.

Pituitary Gland

• The pituitary gland is a pea-sized gland that’s composed of three lobes: anterior, intermediate, and posterior. In many animals, these three lobes are distinct. In all animals, the fleshy, glandular anterior pituitary is distinct from the neural composition of the posterior pituitary.

Pituitary Gland

http://body-disease.com/pituitary-gland-diseases-and-disorders/

Pituitary Gland

• Anterior pituitary hormones:

– Growth hormone

– Thyroid stimulating hormone

– Adrenocorticotrophic hormone

– Prolactin

– Luteinizing hormone

– Follicle stimulating hormone

Pituitary Gland

• Posterior pituitary hormones:

– Antidiuretic hormone (ADH)

• Also known as vasopressin

– Oxytocin

Pituitary Gland

https://ufhealth.org/pituitary-tumors

HPA Axis

http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis

HPA Axis

• CRH is released in response to the following:

– Stress

– Physical activity

– Illness (e.g. infection, which is a form of stress)

– Sleep/wake cycle

HPA Axis

“CRH and vasopressin are released from neurosecretorynerve terminals at the median eminence. CRH is

transported to the anterior pituitary through the portal blood vessel system of the hypophyseal stalk and

vasopressin is transported by axonal transport to the

posterior pituitary.”

HPA Axis

“There, CRH and vasopressin act synergistically to stimulate the secretion of stored ACTH from

corticotrope cells. ACTH is transported by the blood to the adrenal cortex of the adrenal gland, where it rapidly

stimulates biosynthesis of corticosteroids such as cortisol from cholesterol.”

HPA Axis

“Cortisol is a major stress hormone and has effects on many tissues in the body, including the brain. In the

brain, cortisol acts on two types of receptor -mineralocorticoid receptors and glucocorticoid

receptors, and these are expressed by many different types of neurons. One important target of

glucocorticoids is the hypothalamus, which is a major controlling centre of the HPA axis.”

HPA Axis

“Cortisol is a steroid hormone, more specifically a glucocorticoid, produced by the zona fasciculata of the adrenal cortex. It is released in response to stress and a low level of blood glucocorticoid. Its primary functions are to increase blood sugar through gluconeogenesis, suppress the immune system, and aid the metabolism

of fat, protein, and carbohydrate. It also decreases bone formation.”

HPA Axis

“Vasopressin can be thought of as "water conservation hormone" and is also known as "antidiuretic hormone."

It is released when the body is dehydrated and has potent water-conserving effects on the kidney. It is also

a potent vasoconstrictor.”

HPA Axis

“Cortisol produced in the adrenal cortex will negatively feedback to inhibit both the hypothalamus and the

pituitary gland. This reduces the secretion of CRH and vasopressin, and also directly reduces the cleavage of

proopiomelanocortin (POMC) into ACTH and β-

endorphins.”

Cortisol

• Cortisol is essential for optimal function and receptors are found everywhere in the body. Problems can develop when it’s level is either too high or too low.

Cortisol

http://www.coreonehealth.com/images/cort-and-dhea.pdf

Cortisol

• Some problems of having chronically elevated cortisol. – Increases blood sugar through gluconeogenesis.– Decreases GLUT4 transporters (increases blood sugar and

insulin resistance).– Suppresses the immune system in several ways.– Activates anti-inflammatory pathways.– Causes breakdown of lean tissue over time.– Reduces bone formation.– Increases collagen loss - raises the free amino acids in

serum, inhibits collagen formation, decreases amino acid uptake by muscle, and inhibits protein synthesis.

– Stimulates stomach acid secretion.

Sympathomedullary Pathway

• The stress response isn’t just about the HPA Axis and cortisol as some would have you believe. It’s also about the activation of the sympathetic nervous system, which communicates with the adrenal medulla directly.

Sympathomedullary Pathway

“The stress response begins in the brain. When someone confronts an oncoming car or other danger, the eyes or ears (or both) send the information to the

amygdala, an area of the brain that contributes to emotional processing. The amygdala interprets the

images and sounds. When it perceives danger, it instantly sends a distress signal to the hypothalamus.”

Sympathomedullary Pathway

“After the amygdala sends a distress signal, the hypothalamus activates the sympathetic nervous system by sending signals through the autonomic

nerves to the adrenal glands. The sympathetic nervous system functions like a gas pedal in a car. It triggers the fight-or-flight response, providing the body with a burst of energy so that it can respond to perceived dangers.”

Sympathomedullary Pathway

“Adrenaline creates changes in the body such as decreases (in digestion) and increases (sweating,

increased pulse and blood pressure). Once the ‘threat’ is over the parasympathetic branch takes control and

brings the body back into a balanced state. No ill effects are experienced from the short-term response to stress

and it further has survival value in an evolutionary context.”

Adrenaline

• Inhibits insulin secretion by the pancreas.

• Triggers glucagon secretion in the pancreas.

• Stimulates glycogenolysis in the liver and muscle.

• Stimulates glycolysis in muscle.

• Increased (ACTH) secretion by the pituitary gland.

• Increased lipolysis by adipose tissue.

– leads to increased blood glucose and fatty acids.

Acute Versus Chronic Stress

• It is suggested by many that the sympathomedullarypathway is more of a short term response and that the HPA axis is more heavily involved with the chronic stress response. I’m not so sure about this – I think it depends on the individual situation.

General Adaptation Syndrome

• Acute stressors affect an organism in the short term; chronic stressors over the longer term. General adaptation syndrome (GAS), developed by Hans Selye, is a profile of how organisms respond to stress.

General Adaptation Syndrome

• The general adaptation syndrome is characterized by three phases:

1. Acute phase

2. Resistance phase

3. Exhaustion phase

Stages of Adrenal Fatigue

• In the model of “adrenal fatigue” taught by Biohealthand some of the other labs, the adrenals are said to go through the same three stages as proposed by Selye in his general adaptation explanation. It is proposed that using saliva testing that identifies cortisol and DHEA levels, one can identify the stage of “adrenal fatigue”.

Stages of Adrenal Fatigue

http://www.drhagmeyer.com/natural-treatments/stages-of-adrenal-fatigue-part-ii/

Stages of Adrenal Fatigue

• We can measure this proposed decline in adrenal function using a simple saliva test that measures cortisol and DHEA. We’ll look at the precise interpretation of this test in a separate lesson, but basically you take 4 saliva samples at different times of day, and the lab measures 4x cortisols and the DHEA average.

Stages of Adrenal Fatigue

• Stage I:

– High total cortisol; possible declining DHEA.

• Stage II:

– Cortisols high or low during the day; normal total cortisol; declining DHEA.

• Stage III:

– Cortisol low across the board; low DHEA

Other Metabolic Changes

• We’ll look at the salivary adrenal testing separately as I’d like to explore some of the other endocrine and metabolic changes that take place during the stress response.

Other Metabolic Changes

• Studies in critically ill patients (acute stress) can teach us a lot about what happens in chronically stressed people.

Other Metabolic Changes

• Metabolic response to stress:

– Glucose and protein metabolism (incl. insulin)

• Protein catabolism (gut/muscles)

• Gluconeogenesis / cori cycle (gut & muscle breakdown)

– Fluid and electrolyte response

– Endocrine response

– Inflammatory response

– Immunologic response

Other Metabolic Changes

• Endocrine response:

– HPA axis

– Sympathomedullary response

– Thyrotropic axis

– Somatotropic axis

– Lactotropic axis

– LH-testosterone-testosterone axis

Other Metabolic Changes

• It’s not necessarily clear whether each response is governed separately, or whether some of the responses occur due to other responses being activated (i.e. other responses being the result of elevated cortisol or adrenaline).

Other Metabolic Changes

“Serum levels of various vitamins decrease with the inflammatory response, though the clinical significance

of this is unclear. For example, in postoperative patients, levels of vitamins A, C and E are decreased. Septic patients have high vitamin A excretion in the

urine. Levels of B1, B2, B12 and folate are not affected by inflammation.”

Cresci, page. 111.

Other Metabolic Changes

“Serum levels of various trace elements decrease in critical illness. Serum levels of selenium, copper and zinc are decreased. This may be due to increased urinary or

other losses and due to increased protein catabolism.”

Cresci, page. 111.

Other Metabolic Changes

• We know that vitamin C levels can be depleted very rapidly when people have serious infections (see Tom Levy’s book on vitamin C and infections). Even H. pylori is inversely correlated with vitamin C in the blood and gastric juices.

The Steroid Pathways

• In order to continue building our understanding about the metabolic and endocrine effects of stress, it’s prudent to spend a little time looking at the steroid pathways and then investigating how the thyroid and sex hormones might become imbalanced.

The Steroid Pathways

The Steroid Pathways

• The previous slide explains why a cortisol demand can upset the balance of all the other steroid hormones (more detail in the next lesson):

– Often times lowered progesterone

– Occasionally elevated progesterone

– Possibly lowered oestrogen

– Possibly elevated oestrogen

– Lowered DHEA

– Either higher or lower testosterone

– Altered aldosterone levels

The Steroid Pathways

Adrenal – Thyroid – Sex Hormone Link

• You can’t separate these hormone groups. As we go through this module, you’ll quickly see that there are other models that explain the concept of “stress response” and “adrenal fatigue” than simply the consideration of the stage I, II, III general adaptation syndrome model.

Thank You!

• As always, thanks a million for tuning in and consuming this info. It’s been my pleasure sharing this wisdom with you. In Lesson Thirty-two we’ll look at “adrenal fatigue” testing in more detail.