HPA Axis Dysfunction Symptoms

In today's fast-paced world, stress has become an almost constant companion, and our bodies have a sophisticated system to manage it. However, when this system becomes imbalanced—whether due to chronic stress, poor lifestyle choices, or other factors—it can lead to HPA axis dysfunction. 

In this article, we will explore HPA axis dysfunction, related symptoms, the impact of cortisol imbalances, and the testing methods used to treat this often-overlooked health issue.

The Hypothalamic-Pituitary-Adrenal (HPA) axis is a complex pathway between three critical glands in the body: the hypothalamus, the pituitary gland, and the adrenal glands. Your hypothalamus and pituitary gland are located in the brain and your adrenal glands are located on top of each kidney. This system plays a pivotal role in regulating stress response, mood, digestion, immune function, energy storage, and more.

When the body perceives stress, the hypothalamus releases a hormone called CRH, which prompts the pituitary gland to secrete a different hormone called ACTH. This hormone stimulates the adrenal glands to produce cortisol, often referred to as the "stress hormone." Cortisol affects the body by regulating metabolism, reducing inflammation, controlling blood sugar levels, influencing memory, and helping the body manage stress.

In a healthy HPA axis, the hypothalamus senses high levels of cortisol in the blood and responds by turning down the stress response in what is called a “negative feedback” loop. However, chronic stress can cause the adrenals to keep pumping out cortisol. Over time, the feedback to your brain can be affected and lead to either high or low cortisol levels. 

HPA axis dysfunction occurs when there is an imbalance in the regulation of these hormones, leading to either an overproduction or underproduction of cortisol. The most common symptoms of HPA axis dysfunction include:

Difficulty falling asleep or staying asleep is a common sign of HPA axis dysfunction. The body's natural cortisol rhythm is disrupted, leading to elevated levels at night when they should be the lowest. Unfortunately, poor quality sleep can further elevate cortisol levels thus feeding into a vicious cycle.

Anxiety, depression, irritability, and mood swings can all indicate HPA axis dysfunction. The imbalance in cortisol can affect neurotransmitters in the brain, leading to these mood changes.

Persistent tiredness that doesn’t improve with rest can be a hallmark symptom of HPA axis dysfunction. While this is often seen in low cortisol levels, individuals with high cortisol levels may report feeling “tired but wired.”

Cortisol plays a role in digestion, and an imbalance can lead to issues such as irritable bowel syndrome (IBS), bloating, and changes in appetite.

Unexplained weight gain or loss can occur, particularly around the abdominal area. If you are experiencing difficulty losing weight despite diet and lifestyle changes, high cortisol levels may be an underlying cause.

Difficulty concentrating and memory problems are common symptoms due to the impact of cortisol on brain function.

Both high and low cortisol levels can lead to significant health problems. High cortisol levels can lead to symptoms like high blood pressure, rapid weight gain (especially in the face and abdomen), feeling “wired but tired”, and increased risk of diabetes. It can also exacerbate anxiety and interfere with sleep. On the other hand, symptoms of low cortisol include extreme fatigue, muscle weakness, weight loss, low blood pressure, and a decreased ability to handle stress.

A cortisol test measures the level of cortisol in your body. Unfortunately, conventional medicine does not regularly support or fully understand how to treat HPA axis dysfunction. Learn more about the difference between conventional and functional medicine. As a result, most conventional providers and insurance do not provide cortisol testing. However, cortisol testing is an extremely valuable tool to evaluate for HPA axis dysfunction as a possible root cause of various symptoms (like those listed above).

Cortisol follows a circadian rhythm and rises quickly upon waking and lowers slowly throughout the day with the lowest point just before bedtime. Because of cortisol’s rhythmic pattern, testing at only one point in the day does not provide a full picture. Rather, collecting multiple data points throughout the day is the best way to accurately assess your cortisol pattern. For this reason, blood tests are not practical and would require multiple blood draws. However, saliva or dried urine samples offer a practical and accurate method for assessing cortisol patterns (1). When we need to further assess HPA axis dysfunction, we use a six point salivary cortisol test including CAR (cortisol awakening response). 

HPA axis dysfunction can significantly impact various aspects of health, from sleep and mood to digestive health and weight management. Understanding the symptoms and seeking appropriate cortisol testing can lead to effective management and treating the root causes of these symptoms.