In patients with dysautonomia we often find that the hypothalamic pituitary adrenal axis (HPA axis) is not functioning optimally (often called adrenal fatigue). This can cause a host of problems that not only impact quality of life, but may also contribute to disease progression.

The HPA Axis and Chronic Disease

The stress response system is how we maintain homeostasis when presented with challenges of a real or perceived nature. Our response is largely autonomic with significant involvement of the endocrine and immune systems. The HPA axis is the core player in the endocrine component of our stress response system. It functions in concert with the autonomic system. Dysfunctions in these pathways have been associated with numerous pathologic states including inflammatory diseases, autoimmune disease, chronic pain and mood disorders.

Alterations in the HPA axis often accompanies dysautonomia and many other fatigue related disorders. It follows that improving HPA axis function would be beneficial for those patients.

How the HPA Axis Works

hpa axis dysfunction

The HPA axis is an endocrinologic feedback loop. Peptide and steroid hormones secreted by the hypothalamus, pituitary and adrenal glands act on each other in positive and negative feedback mechanisms to maintain homeostasis at baseline and in periods of stress. In turn they influence the thyroid and the gonads. The collective effects of these hormones can have great influence upon the immune system and levels of inflammation. The best known of these hormones is cortisol. Oral or injectable versions of cortisol are commonly used as medical therapy for a host of medical conditions.

Restoring Normal HPA Axis Function

Reestablishment of normal HPA axis function can play a central role in recovery. Rectifying sleep disorders and eating schedules to prevent gluconeogenesis are strategies employed, as are adaptogenic herbs to address HPA axis dysfunction. Oxytocin, which modulates the HPA axis, may also play a role.