555037 Last update: 2023-08-11
The Importance of the Adrenal Glands (2 of 4)

The lack of cortisol, the main glucocorticoid secreted by the adrenal cortex, manifests itself in symptoms that can vary greatly from one person to another.  This feature accounts for much of the difficulty they experience in identifying the cause of their suffering, which is by the way, rarely understood by the majority of doctors.

Considering the involvement of this master hormone in basal metabolism, fatigue (that can become total exhaustion in advanced cases) and weight gain (which can switch to weight loss in severe cases) are common symptoms. The exact same symptoms can also be found in thyroid insufficiency, emphasizing the frequency of glandular weaknesses combining the thyroid and adrenal glands.

The cause of lack of energy can sometimes be traced; for example fatigue in the morning (impossibility to get up) is more thyroid, while fatigue at the end of the day is mainly adrenal. This latter form will get worse under stress irrespective of the time of day, which constitutes a classic aspect of lack of cortisol.

Other symptoms are found in both a lack of cortisol and thyroid hormone: difficulty to concentrate, the famous 'brain fog', poor memory, dizziness, and sometimes a compensatory over-agitation leading to confusion and poor efficiency.

Fortunately, deficiency of glucocorticoids often results in more specific symptoms that better guide the diagnosis. It is the case for hypoglycaemia (but in reality, this can also occur more frequently in hypothyroidism). This condition is most often characterised by a sudden malaise whereby the patient feels the need for sugary foods to feel better; a grave mistake as it will only feed the next crisis and of course will only further deplete glucocorticoid function…

Orthostatic hypotension constitutes another clear symptom directly implicated in cortisol insufficiency, along with evening palpitations, which worsen at bedtime, sometimes to the extent that they become true tachycardia. This should not be confused with palpitations occurring randomly, day or night, in hypothyroid patients whose hormonal treatment is poorly prescribed (excessive). Both types of palpitations can coexist in the same patient when adrenal insufficiency has not been recognised.

Clinical signs suggestive of low cortisol include cold and clammy skin (however cold extremities such as hands and feet, but also the nose, can be recognized in patients suffering from hypothyroidism), or hyperpigmentation of the skin, which is then an almost pathognomonic sign of glucocorticoid deficiency. These brown skin patches on the elbows or knees, darker lines on the palms of hands, and brownish stretch marks represent reliable signs of low cortisol.  Finally another very useful means to establish a diagnosis is the abnormal tendency (for the subject in question) to tan more quickly, which unfortunately in this situation is not as good as one would hope!

Note also, in some patients, a tendency toward salty foods (but tending more towards sweet in response to hypoglycaemia), also a craving towards strong spices, or addiction to caffeine, tobacco and other stimulants. Each instinctively seeks to compensate for the lack of cortisol, a hormone that can be measured in blood, saliva, or - in the form of its various metabolites from liver detoxification – in 24-hour urine collection where they are known as the 17-hydroxysteroids family.

For more information, you are invited to visit my website www.gmouton.com where you will find a detailed Power Point presentation (202 slides in English) in the section Conferences/Functional Hormonology/ Adrenals. Enjoy reading!

By changing nothing, we hang to what we understand, even if it is the bars of our own jail.
- John le Carré, The Russia House 1989

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