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HPA Axis

HPA Axis

If cortisol reduces inflammation, then why do people so often have elevated cortisol and high inflammation at the same time?

Dr. Amy Nett: This is a great question and I think Chris talked about some of the complexity of cortisol...

In a patient with high free cortisol and low metabolized cortisol, we were taught this week that thyroid function could play a role. Can you explain how? Maybe I mistaught myself, but I thought adrenal function worsened thyroid dysfunction. Maybe it’s bilateral, but could you specifically explain the mechanism of action for thyroid dysfunction inhibiting the metabolism of free cortisol? Separately, via the DUTCH testing, I’ve superficially learned that liver dysfunction can also negatively impact this conversion. What kind of liver dysfunction? Are we talking about detoxification or something else?

Chris Kresser: It’s true. High free cortisol and low metabolized cortisol, hypothyroidism is one of the causes of that imbalance,...

The HPA-D unit, you explained DHEA(S)”—That’s total DHEA in serum. Just confirm that that’s what you mean, and not DHEA-sulfate, which is DHEA-S with no parentheses as more sensitive. I had a patient for whom we did DUTCH testing, and her DHEA was in mid-normal ranges. She did a serum DHEA(S), and it showed low levels. How would you approach this?

Chris Kresser: This is another one of those nuances that’s also very confusing and somewhat complex, and you can refer...

I have a two-part question on a new patient. I’m wondering your initial thoughts and where you would be thinking on this case study besides initial workup with labs. A 25-year-old patient, often tired. Pushes through, but it’s a struggle. She was on Vyvanse for a year at the age of 20 and is off it completely. She has taken Sudafed to work through a cold and has noticed helpful cognitive benefits. She doesn’t want to take either of these amphetamines for obvious reasons, but she has tried different amino acids before, and they give her extreme headaches. Sleep is good, and she follows a Paleo diet and lifestyle, but energy and cognitive function are not optimal. She also mentioned it’s hard for her to sleep if she does not eat potatoes with dinner. Where would you start, and how would you start thinking in this case?

Chris Kresser: For sure, I would do a comprehensive workup, and an HPA axis assessment would be a big part...

On page 4 of part 1, HPA axis, it says that adrenaline and noradrenaline are transmitted via nerves.” She says, “I’m very confused. How can a hormone be transmitted by a nerve?

Dr. Amy Nett: The way I think it’s best to think of it is that epinephrine and norepinephrine—and that’s synonymous...

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