The Health Consequences of High Adrenaline and High Cortisol

Most people with thyroid and autoimmune thyroid conditions deal with chronic stress.  In fact, I think it’s safe to say that most people in general deal with chronic stress.  And while I have spoken about cortisol in past articles and blog posts, I haven’t talked as much about adrenaline.  And so what I plan on doing in this post is to discuss some of the factors which can cause high cortisol and adrenaline, some of the symptoms associated with elevated levels, and the consequences of having high levels of cortisol and adrenaline over a prolonged period of time.  And of course I’ll discuss what you can do to naturally lower cortisol and adrenaline.

Most people reading this are aware that adrenaline is involved in the “fight or flight” reaction.  When there is a stressful situation, there will be a rapid increase of adrenaline.  On the other hand, cortisol will also increase, but it’s a slower process.  During a chronic stress situation you can have chronically raised adrenaline and cortisol levels.

Adrenaline is known as epinephrine.  And there is also norepinephrine (noradrenaline).  Both of these are known as catecholamines.  As for how they are formed, the amino acid tyrosine gets converted into DOPA, which in turn gets converted into dopamine.  This neurotransmitter in turn gets converted into noradrenaline.  An enzyme called PNMT converts norepinephrine into epinephrine by catalyzing the transfer of a methyl group from SAMe to norepinephrine.  Both epinephrine and norepinephrine are broken down and inactivated by the enzymes catechol-oxymethyltransferase (COMT) and monoamine oxidase (MAO).  However, if someone has a genetic defect of the COMT gene or the MAOA gene then this can affect the breakdown of the catecholamines.  Fortunately there is genetic testing available to determine if someone has one or both of these genetic polymorphisms.

What Are The Causes/Symptoms Of Elevated Adrenaline?

Before talking about the symptoms of high adrenaline, it probably is a good idea to briefly mention some of the factors which can cause high adrenaline.  In addition to stress, other factors which can cause high adrenaline include not getting enough sleep, having hypoglycemia, pain, anger and fear, and being on certain medications.  If someone has high adrenaline then they can experience one or more of the following symptoms:

• Anxiety
• Elevated heart rate
• Elevated blood pressure
• Heart palpitations
• Low insulin and blood glucose
• Headaches
• Hot flashes

What Are The Causes/Symptoms Of Elevated Cortisol?

In addition to stress causing elevated cortisol levels, other factors include not getting enough sleep, inflammation, infection, blood sugar imbalances, and trauma (both emotional and physical).  Here are some of the symptoms one can experience with elevated cortisol levels:

• Memory and concentration problems
• Problems falling and/or staying asleep
• Depression
• Elevated blood glucose levels
• Low sex hormones due to the pregnenolone steal

What Are The Consequences Of Prolonged Elevations Of Adrenaline and Cortisol?

Although having elevated adrenaline and cortisol levels for short periods of time is normal under the presence of an acute stressor, if someone is dealing with prolonged chronic stress then this can not only cause the symptoms I mentioned earlier, such as anxiety, depression, hypertension, low sex hormones, and blood sugar imbalances, but it can also lead to osteoporosis, as well as cognitive impairment.

The hippocampus, which is important in learning and memory, is particularly sensitive to chronic stress and cortisol (1).  There is evidence that prolonged elevations of cortisol can compromise the hippocampus, and this can affect cognition (1) (2).

In addition, if someone has elevated cortisol levels for a prolonged period of time, this can lead to cortisol resistance.  You might be familiar with insulin resistance, which is when there is an excess of insulin, and the cells are no longer responsive to the effects of insulin.  It’s similar with cortisol, as large amounts of cortisol can result in a decreased negative feedback of the cortisol-ACTH feedback system resulting in increased ACTH secretion. This causes higher plasma cortisol and also increases the production of adrenal mineralocorticoids (3).  This not only can affect someone’s ability to handle stress, but it also can interfere with the regulation of the inflammatory process (4).

What Impact Does Elevated Cortisol and Adrenaline Have On Thyroid Health?

Cortisol seems to have a greater impact on thyroid health than adrenaline.  In past articles I have discussed how elevated cortisol levels can affect the conversion of T4 to T3.  This will result in low or depressed T3 levels, and an elevated reverse T3.  Studies show that stress can inhibit both type I iodothyronine 5′-deiodinase activity (5), as well as type II 5′-deiodinase activity (6) (7).

What Is Cushing’s Syndrome?                                  

Cushing’s syndrome is a condition which involves the body being exposed to excessive amounts of cortisol.  Although this can be caused directly by the adrenals releasing too much cortisol, it can also be caused by an excess of ACTH released by the pituitary gland, which in turn will lead to excess cortisol.  In fact, the latter problem is more common, as many people with Cushing’s syndrome have a pituitary adenoma that is responsible for the excess amount of ACTH, which is referred to as Cushing’s disease.  An adenoma is a benign tumor, and sometimes it can be difficult to diagnose.  Cushing’s syndrome can also be caused by taking an excess amount of prescription corticosteroids.

Although some of the symptoms of Cushing’s syndrome are similar to those with high cortisol, this is an extreme condition, and the symptoms are usually more severe.  Here are some of the symptoms associated with this condition (8):

• Weight gain
• Skin changes
• Menstrual irregularities
• Muscle loss and weakness
• Osteopenia or osteoporosis
• Elevated blood glucose levels
• High blood pressure
• Infections
• Dyslipidemia

As for how Cushing’s syndrome is diagnosed, in addition to having elevated cortisol levels in the blood, a urinary cortisol test might also be performed.  ACTH should also be tested, and if this hormone is elevated then a pituitary adenoma is the most likely cause of the excess cortisol release, although an ectopic source is also possible.  If cortisol is high but ACTH is normal then there might be an adrenal tumor.  Other tests commonly used include a high-dose dexamethasone suppression test, a corticotropin-releasing hormone test, and sometimes a CT scan or MRI will be conducted in order to detect the presence of a pituitary or adrenal adenoma.

If Cushing’s syndrome is due to a pituitary or adrenal adenoma, then surgery is commonly recommended.  If the pituitary adenoma can’t be identified, then partial surgery of the pituitary gland might be conducted.  If this procedure is performed then hormone replacement therapy is necessary. If someone has an adrenal gland tumor then the affected adrenal gland is usually removed. Sometimes radiation is used to shrink the adenoma.  Prescription drugs might also be used to control cortisol production.

How Can You Test For High Cortisol or Adrenaline?

Many reading this know that I prefer testing the cortisol levels through the saliva.  Although testing cortisol through the blood has some value, I prefer the saliva because it allows you to look at the circadian rhythm  of cortisol, whereas with serum testing you are relying on a single sample, which doesn’t always tell the entire story.  In addition, it’s common for false elevations of cortisol to occur when testing through the blood, and the main reason for this is because cortisol increases during stressful situations, and many people find it stressful to get blood drawn.  You can also test for the urinary cortisol metabolites, although this is something that I personally don’t do in my practice.

With regards to testing for adrenaline, although you can test adrenaline in the blood (along with norepinephrine), urine testing is more commonly used.  Usually a 24-hour urine collection is recommended.  Organic acids is another option, as this measures a metabolite called vanilmandelate, which usually increases when someone has elevated adrenaline levels.  You can also test for genetic polymorphisms of COMT and MAO-A, which help to break down adrenaline.  I’ll discuss these in a little more detail shortly.

How Can You Decrease Cortisol and Adrenaline?

1. Reduce your stress levels.  Since stress causes an increase in cortisol levels, it makes sense to do everything you can to try to reduce the stress levels in your life.  Although I realize that reducing the stress in your life isn’t always possible, what I recommend is to write down all of the major and minor stressors in your life, and  try to determine if you can eliminate some of these stressors.

2. Improve your stress handling skills.  Whether or not you can reduce your stress levels it is a good idea to do things to improve your stress handling skills.  After all, one’s perception of the stressor usually plays a greater role than the stressor itself.  In order to help accomplish this I recommend to incorporate one or more mind-body-medicine techniques such as yoga, meditation, biofeedback, or another technique.  Also consider utilizing acupuncture and massage, as these can also help with high cortisol and adrenaline levels.

3. Nutrients and herbs which lower cortisol.  Some of the nutrients and herbs which can lower cortisol include magnolia and Phellodendron bark (relora) (9) (10), phosphatidylserine (11) (12), and  ashwagandha (13) (14).

4. Nutrients and herbs which lower adrenaline.  GABA is an inhibitory neurotransmitter, and this can decrease adrenaline levels (15). GABA doesn’t seem to cross the blood brain barrier unless if it has a phenyl group attached, although you can also take nutrients and herbs which increase GABA production.  For example, both L-theanine (16) and valerian root can both increase GABA (17) (18).

5. Protect the hippocampus.  I mentioned earlier how prolonged elevations of cortisol can compromise the hippocampus.  Well, there is evidence that the herb Bacopa monniera can help to protect the hippocampus from damage (19) (20) (21).

6. Test for COMT and MAO-A polymorphisms.  Since the enzymes COMT and MAO-A help with the breakdown of adrenaline, if you continue to have chronically elevated adrenaline even after incorporating stress management and taking some of the nutrients I discussed, then you might want to do some testing to see if you have a COMT and/or MAO-A polymorphism.  While you can’t reverse these genetic polymorphisms, you can give nutritional support to help with these defects.

So hopefully you have a better understanding of the impact high cortisol and adrenaline can have on your health, and what you can do to try to lower these.  Some of the symptoms of high cortisol include anxiety, elevated heart rate and blood pressure, heart palpitations, low insulin and blood glucose, headaches, and hot flashes.  High cortisol frequently leads to memory and concentration problems, problems falling and/or staying asleep, depression, and low sex hormones.  Some of the things you can do to reduce cortisol and adrenaline include lowering your stress levels and improving your stress handling skills, and certain nutrients can also help such as relora, phosphatidylserine, ashwagandha, valerian root, and L-theanine.