HPA Syndrome – Lab Tests for HPA Dysfunction/Hormones

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Your HPA glands produce hormones that help your body to cope with stress and maintain health. Under chronic stress these glands become fatigued, impairing hormone production and balance. To resolve stress-related symptoms and health problems, the HPA hormones must be balanced. Absent laboratory testing, misdiagnosis is understandable given the disparate sources and symptoms indicative of HPA exhaustion. An incorrect assessment usually results in symptoms being treated while the root cause remains undiagnosed.

It is now possible to assess the health of your HPA glands and pinpoint hormone imbalances using the Functional HPA Stress Profile.

This important lab test from Biohealth identifies the impact of chronic stress. It is an inexpensive, easy-to-use saliva test that evaluates the HPA glands and identifies hormone imbalances. It provides scientific guidance, so that your provider can develop a specific treatment plan to balance the HPA hormones and correct health problems caused by stress.

The foundation of all HPA stress testing involves measurement of Cortisol and DHEA. Additional hormones can be measured as necessary, with the most common being: androstenedione, dihydrotestosterone (DHT), estradiol, estriol, estrone, melatonin, progesterone, and testosterone.

Note how the most commonly tested hormones fit into the hormone pathways (with pregnenolone steal AKA cortisol escape emphasized)



The HPA glands produce the complementary hormones cortisol and dehydroepiandrosterone (DHEA). The Functional HPA Stress Profile from Biohealth assesses the levels of cortisol and of the sulfated form of DHEA: DHEA-S.

This profile assesses the body’s ongoing level of HPA response to both internal and external stressors. The Functional HPA Stress Profile is easily performed at home, work, or on the go, with specimens mailed directly to the lab. Four saliva samples are taken throughout the course of a typical day, so that the cortisol rhythm can be determined using 4 specific time windows. Two of these samples provide an average DHEA-S value. Using the pattern, as well as the ratio of cortisol to DHEA, this profile can identify stages I through III of HPA exhaustion.

Cortisol Rhythm
The salivary free fraction of the HPA cortisol output is reported because of its high clinical correlation. Since measuring the total daily cortisol output is impractical, the sum of four individual cortisol levels is taken at specified intervals throughout the day: in the morning between 6-8 am, near noon between 12-1 pm, in the late afternoon between 4-5 pm, and at nighttime between 10 pm-12 am. The normal sum of these four readings is 23-42 nM, with the ideal being 34-36 nM. (All references are specific to the panels available from Biohealth Diagnostics Lab).

In the presence of stressors, the body almost immediately attempts to increase cortisol levels. This increase is associated with both an endocrine and an autonomic response in preparing the body to defend itself. Elevated cortisol levels for extended periods, however, negatively affect virtually every aspect of physiology. It becomes more difficult to maintain proper blood sugar levels, to slow down for rest, recovery, and repair, to get good quality sleep, to balance other hormones, to maintain mucosal surface integrity, to maintain bone mass, to produce effective immune function, to effectively regulate inflammatory processes, or to detoxify the body. Without proper intervention, continued HPA hyperstimulation can lead to HPA exhaustion, and eventually HPA failure can occur. The degree and timing of various cortisol imbalances provide the health professional with invaluable insight into the nature of the causative stressors, and allow the practitioner to formulate a remedial protocol.

DHEA-S Average
DHEA is the major precursor of testosterone and the estrogens. The more active, sulfate form of DHEA is DHEA-S, which provides a more reliable measure of DHEA levels. We report the average of two DHEA-S values, taken between 12-1 pm, and between 4-5 pm. The normal DHEA-S level is 2.0-10.0 ng/ml, and the ideal is 7.0-8.0 ng/ml. DHEA is an important modulator of many physiological processes. It promotes the growth and repair of protein tissue, especially muscle, and acts as a counter-regulatory agent to cortisol, negating many of the harmful effects of excess cortisol. Over extended periods of an increased demand for cortisol, DHEA levels decline, and DHEA is then no longer able to counter-regulate the negative effects of excess cortisol. Depressed DHEA levels serve as an early warning of potential HPA exhaustion.

A chronic imbalance between HPA stimulation and cortisol and/or DHEA output is associated with a multitude of both clinical and subclinical systemic disorders. Chronically depressed DHEA results in an imbalance in sex hormones. Abnormal cortisol and/or DHEA values, either elevated or depressed, result in decreased activity of the immunocytes that produce secretory IgA (sIgA). SIgA provides a mucosal first-line immune defense against virtually every pathogen, including parasites, protozoa, yeasts, fungi, bacteria, and viruses. SIgA also protects against inflammatory reactions to food antigens. Dysfunctional mucosal immunity is associated with an increased risk of infections and of adverse food reactions.

Saliva as a Testing Medium
Unlike blood or urine hormone testing, saliva analysis assesses the biologically active compounds that are active at the cellular level. Salivary hormone analysis represents what is clinically relevant and conveys the patient’s true hormonal activity, especially when multiple samples are collected over the course of a day or more. In comparison, blood analysis assesses compounds in the blood serum, most of which are protein bound. When released from their protein carriers, the compounds become free. Measuring the concentration of non-bioavailable forms in urine or serum is irrelevant since the data is insufficient as to the concentration of the more clinically significant free hormones in circulation found in saliva.

As a diagnostic fluid, saliva is the most convenient, non-invasive specimen available for the patient. Invasive procedures, such as blood draws, are not just extremely impractical and costly when it comes to acquiring multiple samples; they also cause a stressful event on the body which can promote a release of cortisol, thus skewing the result for one event.

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