Cortisol is a hormone produced by the adrenal glands and is known as the hormone that allows us to cope with stress. A lack of cortisol is treated only in case of adrenal insufficiency, a serious and potentially life-threatening condition.
Complementary medicine often refers to adrenal function or adrenal exhaustion (adrenal fatigue syndrome). This is a form of fatigue caused by moderate adrenal function and reduced cortisol production as a result of chronic physical, mental or emotional stress. The stress-regulation system is called into play in many other reactions in the body, such as in the case of allergy. Chronic allergic reactions e.g. increased intestinal permeability, also known as “leaky gut”, can also result in adrenal imbalance. This is referred to as allergic fatique syndrome, which is not itself a medical condition but a symptom of diseases such as chronic fatigue syndrome, fibromyalgia or burnout.
The production of cortisol follows a day-night rhythm. In order to check whether the adrenal gland is functioning properly, you collect three saliva samples during one day at three different times that are examined for cortisol. When the day-night rhythm is shifted, very normal values can be found by chance, while the whole pattern is shifted for a few hours and there is still a subfunction. A lack of cortisol (hypocortisolism) is associated with fatigue, muscle weakness, joint pain, susceptibility to infection, autoimmunity, allergy and depression. Many of these symptoms can be seen in chronic fatigue, fibromyalgia and burnout and many researchers believe that Chronic Fatigue Syndrome is a form of adrenal insufficiency.
Lack of cortisol that is not the result of adrenal insufficiency, in which the adrenal glands are no longer able to produce sufficient cortisol, is called relative, or reactive hypocortisolism. Although the function of the adrenal glands is important for the production of cortisol, the adrenal glands are not always the problem in reactive hypocortisolism.
The stress response is extremely complex and is not only regulated by the adrenal glands. Instead of cortisol insufficiency, the body can become insensitive to cortisol (cortisol resistance).
Since the production, excretion and activity of cortisol depend on many different factors, the administration of corticosteroid drugs is not always the right approach, except in the case of true adrenal insufficiency. It is not always simply a question of increasing or decreasing cortisol or supporting adrenal function, but of restoring the stress response (the hypothalamic-pituitary-adrenal axis) so that the body is once again able to adjust the production and activity of cortisol to the needs of the moment. Interestingly, many patients very well to very small amounts of hydrocortisone(5-10 mg) with strong improvement in their stress response. After a few weeks, this improvement is still evident. The same can be achieved with hormone-free adrenal extracts from neonatal calves.