Chronic Stress and Adrenal Response

hpa-axis-stress-response

The hypothalamic pituitary adrenal (HPA) axis is our central stress response system.

In March of 2020 the specter of COVID-19 began to rise across the United States, Maryland went from three cases on March 5th to closing all non-essential businesses just a few weeks later.

Back in January, my partner and I had begun, at breakneck speed, to plan our April wedding. With each passing day in March, it became clearer that the wedding we had planned for about eighty guests at a beautiful nature preserve could not go forward. From February to late March 2020 we also saw the rapid decline of the stock market.

I can not say with certainty, as I was not tracking my state of mind day by day, but I remember weeks, maybe a month or more, where I felt under constant crushing stress. I became almost frantic as I watched my savings, expected to fund my retirement, declining rapidly before my eyes. I was desperately looking to figure out what to do with my savings and meanwhile, we had a wedding to plan, as our days were increasingly spent isolated in our home. I was the daily voice of doom to my partner, a man who would become my husband a month later.

In mid-March, Maryland’s Governor Hogan issued an order banning gatherings of 50 or more and it became clear that our wedding could not proceed. We sent an email to our guests that read in part, “Events are moving fast, and today, Governor Hogan of Maryland, by executive order, following yesterday’s CDC recommendation, has prohibited all events and gatherings of over 50 people AND shut down all restaurants, bars, fitness centers and theaters in the state of Maryland. Given this, we will be forced to cancel our wedding planned for April 25th and all surrounding events.” But we also said in the same email, “Fear not, we are still planning to get married on April 25. What we are beginning to plan for is a very small gathering in our home and simultaneously to broadcast the wedding service online. This is in the early planning stage. More information to follow as we work through the details.”

Thus began a five-week sprint, with all kinds of twists and turns as the COVID-19 pandemic unfolded, to plan a virtual wedding. The small gathering we envisioned for our wedding morphed as the scale of pandemic unfolded. On our wedding day, it was only my husband and me standing between two cameras and a large monitor in our living room. Our officiant and our three readers were displayed on a large monitor with a webcam, and all of our guests, expanded to about one hundred and eighty people, were all virtual watching through another webcam in the comfort of their homes.

During this same period, I was trying to make sense of my savings. I believed at the time that the country was heading towards a depression on the scale of the Great Depression. I still believe we are headed in that direction but the CARES Act and the Payroll Protection Program hastily rolled out by Congress, halted the slide in the stock market temporarily, and caused it to rise. 

Back in March, I rapidly moved a good portion of my savings out of the stock market into fixed income instruments like certificates of deposit. I did not care about the money I had lost, I just wanted to stop the downward slide of my savings and also stop the frantic way my mind had been swirling with fear and anxiety. I wanted to be able to sleep through the night without waking up in the middle of the night only to lie in bed scared and worried for hours. I wanted to stop the constant doom and gloom talk with my partner. I wanted to begin to feel safe and at ease again.

I found this whole period extremely stressful and I went through weeks of depression, anxiety, and stress. The pressure and stress started to lessen when I moved half of my savings out of the market and when a plan began to take shape for our virtual wedding.

Even now, as Michelle Obama said in her podcast this past week, I too feel a constant, “low-grade depression” from what I see going on the world around me: the uncontrolled pandemic; the racial injustice; and the callous and cruel way our leadership in Washington has responded to the national protests over the death of George Floyd.

Given this background, could this extended period of stress, which at its peak lasted over a month, and to a smaller degree continues to this day, have caused an adrenal meltdown. I use the term meltdown because I do not yet have the words to describe what is happening medically.

“Chronic reactivation of a sensitized stress response exhausts the HPA axis, and cortisol dysfunction is commonly implicated in idiopathic pain and inflammation. Chronic stress-induced hypocortisolism has been well documented and linked to pain somatization disorders, such as fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, and temporomandibular disorder. Long-term stress has been shown to attenuate the cortisol awakening response and contribute to morning fatigue, pain, and inflammation. In a study of 121 middle-aged adults, a blunted cortisol awakening response was predictive of pain and fatigue later that day. Similarly, hypocortisolism has been associated with low back pain, and a low cortisol awakening response was associated with leg pain intensity, pain catastrophizing, and low coping scores in 42 patients diagnosed with lumbar disk herniations. Furthermore, long-term follow-up investigations have suggested a predictive relationship between hypocortisolism and new-onset musculoskeletal pain.”

Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation by Kara E. Hannibal, Mark D. Bishop

 

The HPA axis, (hypothalamic–pituitary–adrenal axis), described in the excerpt above drives what is described as Chronic stress-induced hypocortisolism. Hypocortisolism referees to damage or impairment to the adrenal glands, which results in low levels of cortisol and aldosterone hormones.

As I read about this issue, I am learning that I have some classic symptoms of adrenal fatigue, waking up exhausted after a good night’s sleep; ready to go back to bed after I’ve gotten up; low-grade nausea; and having a hard time getting over stressful situations. 

I have spent the last two weeks being tested for what my doctors suspected was a kidney stone, only to find after a CT scan yesterday, that there is no stone. My well-meaning primary care doctor began to ask about the quality of my mattress as a cause of my flank pain and other symptoms. My mattress? My urologist, with a negative diagnosis for a kidney stone, washed his hands of me and suggested I go back to my PCP. I hope to meet with a new doctor who specializes in hormones later this coming week.

I am reading a wonderful book called, Stop The Thyroid Madness, by Janie A. Bowthorpe, M.ED. The chapters on adrenals led me to research this topic further online, which led to the NIH article I quote at the beginning of this essay.

I feel like I am onto something here. While I am at the beginning of a new set of questions, tests, and exploration, I think I am headed in the right direction to begin to solve the issues I have been experiencing physically.

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