The Basics

The adrenal glands are two walnut-sized glands that sit on top of each kidney. They may be small but they exert powerful effects throughout the body. These glands are responsible for manufacturing and secreting steroid hormones such as cortisol, estrogen, and testosterone. Further, they regulate processes throughout the body such as electrolyte balance, blood sugar balance, and blood pressure.

Laboratory Testing

Function in the Body

The adrenal glands’ main purpose is to enable the body to deal with stress. This ancient system was designed to be activated to keep you out of danger’s way. When the adrenal glands are activated, they mobilize the body’s resources in order to escape or fight off danger. This is commonly known as the “fight or flight” response and it is mediated by epinephrine or adrenaline as well as the stress hormone, cortisol.

Historically this fight or flight response to stress was only activated in short spurts when we were physically being attacked, hunted or perhaps hunting for our next meal. Once the event was over, the “rest and digest” system kicks in and adrenaline production ceases.

Problems arise, however, when the adrenal glands all of a sudden have to deal with the stressors of living in the 21st century. The body is unable to distinguish the stress associated with a tiger chasing us from the stress of being overworked, stuck in traffic, having a lover’s quarrel or skipping a meal. These modern-day stressors still activate the fight or flight system and adrenaline and cortisol are released.

Adrenal Overdrive

When we are chronically stressed, the adrenal glands will try to manage this stress by pumping out adrenaline and cortisol in high levels. The body will constantly be on alert. This condition is extremely common in today’s society as our stressors are never short-lived. We work for long hours, worry about money, raise children without much help, and are surrounded by city noise. Even something as innocent as watching the daily news can cause our cortisol levels to rise as we become aware of worldly disasters, deaths, and other disheartening reports.

Cortisol levels are naturally at their lowest level around bedtime. For people with adrenal overdrive, these low cortisol levels are never reached and sleep can be affected. My patients in adrenal overdrive often describe themselves as being “tired but wired” or unable turn their brain off at night. One other clue of high evening cortisol is waking up in the middle of the night, usually around 3-4am.

Adrenal overdrive will show up on an Adrenal Stress Test as high cortisol levels throughout the day or sometimes normal cortisol levels during the day but high levels at night before bed.

Top Symptoms of Adrenal Overdrive

  • Trouble falling asleep or feeling “tired but wired”
  • Waking up at 3-4am
  • Morning fatigue
  • Afternoon slump in energy
  • Brain fog or problems focusing
  • Cravings for sweet, salty or carb-rich foods
  • Anxiety or depression
  • Overweight or difficulty losing weight

Top Symptoms of Adrenal Fatigue

  • Extreme fatigue or feeling “burnt out”
  • Morning fatigue
  • Frequent illnesses
  • Brain fog or problems focusing
  • Low motivation and drive
  • Cravings for sweet, salty or carb-rich foods
  • Anxiety or depression
  • Trouble gaining weight
  • Low libido

Adrenal Fatigue

If high levels of stress are maintained for years, the adrenal glands will eventually start to lose their function and cortisol levels will start to drop. This is known as adrenal fatigue.

This drop in cortisol will largely manifest as a loss of energy. For some, this fatigue will be debilitating and persist throughout the day. This problem is compounded by the fact that low cortisol levels will impact thyroid function. When this happens, symptoms of both adrenal fatigue and a sluggish thyroid can present.

Alongside cortisol, estrogen, progesterone, and testosterone levels will fall too. For women who are reaching menopause, the lack of hormonal support from the adrenal glands will result in more severe menopausal symptoms after the ovaries go into retirement. The lack of testosterone production in women will have a dramatic effect on libido as well.

Adrenal fatigue is often seen as low levels of cortisol on a salivary cortisol test. The levels remain low throughout the day and into the evening.


The first step to treating the adrenal glands is to ensure that your problem is truly originating within the adrenal glands as the symptoms of adrenal overdrive and adrenal fatigue are similar to other conditions. This can be achieved using a simple saliva test for cortisol that is collected 4 times throughout the course of a day known as an Adrenal Stress Test.

The second benefit of testing is that you can confirm whether your problem is resulting from too much cortisol (adrenal overdrive) or too little (adrenal fatigue). The treatments will be focused on either reducing cortisol levels or raising them, respectively.