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Stress is a normal physiological response to stimuli that threaten or challenge our body. All these processes are self-regulated very precisely, by hormonal axes.
While some degree of stress has a positive effect in the maintenance of alertness before these situations, perpetuation over time of such stimuli is detrimental, because maintained and constant activation of this situation leads to hormonal deregulation causing the appearance of a large variety of signs (decrease in insulin sensitivity, increased gluconeogenesis, increased bone resorption and osteoporosis, accumulation of fat around the waist, water and sodium retention, decreased generalized immune response, increased rate of infections and decreased vitality) that can lead to a general pathologic status.
Some processes such as tissue damage, inflammation, physical trauma, emotional trauma, different types of food intolerances, chronic fatigue, fibromyalgia, insomnia, osteoporosis, hypothyroidism, premenstrual syndrome, immune function depressed and obesity, are inducers of maintained adrenal stimulation (stressors).
The physiological manifestation of adrenal stimulation is an increase in the concentration of cortisol, the effects of which are counteracted by the dehydroepiandrosterone (DHEA-S) hormone.
The balance of both hormones ensures the correct operation of the system. When the stressor is maintained, DHEA-S levels eventually go down so they can not counteract the effects of hypercortisolism.
The adrenal status is determined by measuring cortisol concentrations and the sulfated form of DHEA in saliva samples, collected at different times of the day.
Cortisol has a circadian biorhythm (maximum values in the morning upon rising, sharp decline at noon followed by a slow decline until minimum values at midnight), so measurements are taken at 8:00, 12:00, 16:00 and 24:00 hours. The DHEA-S levels are more stable throughout the day and only two measurements are made (at 12:00 and 16:00).
The results are shown in the two graphs below:
Figure 1: Cortisol biorhythm
This graph shows the circadian pattern biorhythm of a patient's cortisol (blue area) and the abnormal pattern in which all or some of the points fall outside this area.
Figure 2: DHEA-S v’s cortisol
The graph represents the equilibrium between the two hormones, showing the average values of DHEA versus cortisol at 12:00 and 16:00H. The area in which the result is found indicates adaptive stress response.
Normal Area: both hormones are within their reference ranges.
Area A1: acute stage in which a stressful stimulus rises the cortisol response and the DHEA-S to counteract this effect.
A2-A5 Areas: stages in which there is a failed attempt to adapt to the stressful situation leading to poor adaptation. DHEA-S levels are maintained to counteract cortisol increase and the tendency of both is to decrease, indicating adrenal fatigue.
Area C: if the situation is not solved, this area of adrenal exhaustion is reached.
Area B: this situation is usually genetically determined, so these patients are more sensitive to stressors.