In a Chronic Stress Response all body functions have become compromised due to prolonged hormone, immune and metabolic breakdown that can lead like falling dominoes to a cascade of chronic degenerative diseases from which the weakened body has a reduced chance to recover. Adrenal exhaustion progresses in three stages. Adrenal Function Testing is the most accurate determination of which stage you may find yourself.
Stage I is distinguished by an increase in output of ACTH by the anterior pituitary gland, increased adrenocortical stimulation, increased cortisol output and an increased probability of pregnenolone steal and decreased DHEA. When in a Chronic Stress Response, pregnenolone, the common precursor to cortisol, DHEA and other hormones is preferentially diverted to cortisol production at the expense of the rest of the steroidal hormones. Generally in Stage I cortisol increases and DHEA and its metabolites decrease or an imbalance occurs especially between testosterone and estrogen.
Stage II Adrenal Exhaustion is marked by the transition from increased to decreased cortisol output. This stage is characterized by continuing high levels of ACTH and thus: adrenocortical stimulation, normal total cortisol output, low or borderline low morning, noon or afternoon cortisol levels, normal nighttime cortisol level, and an increased probability of pregnenolone steal and a further decrease in DHEA. This is a transitional phase in which although ACTH stimulation remains high or even increases, the adrenal output of cortisol declines due to the adrenal fatigue associated with continued hyper stimulation.
Stage III Adrenal Exhaustion is an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. This stage is characterized by continuing high levels of ACTH and thus adrenocortical stimulation, low total cortisol output, and increased probability of a low nighttime cortisol level and pregnenolone steal and even further decrease in DHEA. The adrenal glands are now exhausted to the point that even though there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are unable to return the system to homeostasis.
Adrenal Function Tests have been specifically developed to assess the level of patients' adrenal function. Since cortisol levels ideally fluctuate according to a daily circadian, peaking in the morning and decrementing to a low at bedtime only to rise again over night, four time-specific saliva samples are collected during a "normal" day (morning, noon, afternoon and nighttime). Testing can include DHEA-S levels, one taken on the noon sample and one on the afternoon sample plus morning estradiol, estriol and testosterone as well as bedtime progesterone and melatonin.
For a complete description of Cortisol rhythm and its consequences visit http://www.biodia.com/resources/resources_value_of_adrenal_stress_testing.html