The term Adrenal Fatigue can in many ways be misleading, because it describes a variety of different states that we reach on the path to adrenal exhaustion. In fact, most Adrenal Fatigue sufferers thankfully never reach the latter stages of the condition, and often recover fully from stage 1 or stage 2 Adrenal Fatigue without ever being properly diagnosed.
During the various stages of this condition, hormone and neurotransmitter levels can fluctuate dramatically. In order to correctly interpret the lab tests used to detect Adrenal Fatigue, we need to fully understand the way that the body’s systems interact during each of these stages. Only then can we pinpoint the stage of Adrenal Fatigue that we have reached, and begin an appropriate treatment plan.
On this page I’m going to summarize the four discrete stages of Adrenal Fatigue. As you will see, the gradual development of adrenal exhaustion is a complex process.
Stage One: Beginning the ‘Alarm’ phase
This stage describes the body’s immediate reaction to a stressor. As mentioned elsewhere on this site, this stressor can be an imminent physical threat, or something as simple as a job interview or hospital stay.
During this first phase of the stress reaction, the body is capable of making significant amounts of the hormones that you need to mount a response. If you get lab tests during this stage, they would show elevated levels of epinephrine (adrenaline), norepinephrine, cortisol, DHEA and insulin.
During this stage you will likely benefit from a state of increased arousal and alertness. However, sleep patterns may begin to suffer and you may feel intermittent tiredness. Individuals rarely report their symptoms during this phase, and in fact many of us go in and out of Stage One multiple times throughout our lives.
Stage Two: Continuing the ‘Alarm’ phase
As the stress response continues, so does your body’s reaction to it. During this second stage, your endocrine system is still fairly well equipped to produce the hormones that you need, but your levels of DHEA and other sex hormones may start to drop. This is because the resources needed to produce the sex hormones are being diverted to production of stress hormones like cortisol.
During this stage you will start to feel the effects of over-exertion of your adrenals. A common feeling is that of being “wired but tired”, where you are maintaining alertness when you need it during the day, but then crashing hard in the evening. Many Adrenal Fatigue sufferers begin to develop an unhealthy dependence on coffee during this stage.
Stage Three: The ‘Resistance’ phase
During this stage, your endocrine system continues to focus on producing stress hormones at the expense of sex hormones. This means that you will start to see substantial drops in hormones like DHEA and testosterone, as hormone precursor material is diverted towards the cortisol production pathway. The key here is a hormone named pregnenelone, which is the precursor to both the sex hormones and cortisol. This diversion is named the ‘pregnenelone steal’.
At this point, the individual is still able to function, hold a job and continue a pretty normal life. However, he is experiencing lower levels of many important hormones and this can make a significant difference to his quality of life. Typical symptoms might include regular tiredness, a lack of enthusiasm, regular infections and a lower sex drive. This phase might continue for several months or even years.
Stage Four: The ‘Burnout’ phase
After some time the body simply runs out of ways to manufacture stress hormones, and cortisol levels finally begin to drop. Now, the levels of both the sex hormones and the stress hormones are low. Levels of neurotransmitters are often also low. This is what is sometimes called ‘burnout’ (a term coined by Dr. Fredenberger), and it is what happens when we finally crash after a long period of coping with stress.
During this final stage of Adrenal Fatigue, an individual can suffer from extreme tiredness, lack of sex drive, irritability, depression, anxiety, weight loss, apathy and disinterest in the world around him. In fact, this general hormonal insufficiency has important implications for almost every part of the body. To recover from Stage Four Adrenal Fatigue requires significant time, patience and often and complete change in lifestyle.