Stages of Adrenal Fatigue


These are the four stages of adrenal fatigue.

Stage One: Beginning the ‘Alarm’ phase

This stage describes the body’s immediate reaction to a stressor. As mentioned elsewhere on this site, this stressor can be an imminent physical threat, or something as simple as a job interview or hospital stay.

During this first phase of the stress reaction, the body is capable of making significant amounts of the hormones that you need to mount a response. If you get lab tests during this stage, they would show elevated levels of epinephrine (adrenaline), norepinephrine, cortisol, DHEA and insulin.

During this stage you will likely benefit from a state of increased arousal and alertness. However, sleep patterns may begin to suffer and you may feel intermittent tiredness. Individuals rarely report their symptoms during this phase, and in fact many of us go in and out of Stage One multiple times throughout our lives.

Stage Two: Continuing the ‘Alarm’ phase

As the stress response continues, so does your body’s reaction to it. During this second stage, your endocrine system is still fairly well equipped to produce the hormones that you need, but your levels of DHEA and other sex hormones may start to drop. This is because the resources needed to produce the sex hormones are being diverted to production of stress hormones like cortisol.

During this stage you will start to feel the effects of over-exertion of your adrenals. A common feeling is that of being “wired but tired”, where you are maintaining alertness when you need it during the day, but then crashing hard in the evening. Many Adrenal Fatigue sufferers begin to develop an unhealthy dependence on coffee during this stage.

Stage Three: The ‘Resistance’ phase

During this stage, your endocrine system continues to focus on producing stress hormones at the expense of sex hormones. This means that you will start to see substantial drops in hormones like DHEA and testosterone, as hormone precursor material is diverted towards the cortisol production pathway. The key here is a hormone named pregnenelone, which is the precursor to both the sex hormones and cortisol. This diversion is named the ‘pregnenelone steal’.

At this point, the individual is still able to function, hold a job and continue a pretty normal life. However, he is experiencing lower levels of many important hormones and this can make a significant difference to his quality of life. Typical symptoms might include regular tiredness, a lack of enthusiasm, regular infections and a lower sex drive. This phase might continue for several months or even years.

Stage Four: The ‘Burnout’ phase

After some time the body simply runs out of ways to manufacture stress hormones, and cortisol levels finally begin to drop. Now, the levels of both the sex hormones and the stress hormones are low. Levels of neurotransmitters are often also low. This is what is sometimes called ‘burnout’ (a term coined by Dr. Fredenberger), and it is what happens when we finally crash after a long period of coping with stress.

During this final stage of Adrenal Fatigue, an individual can suffer from extreme tiredness, lack of sex drive, irritability, depression, anxiety, weight loss, apathy and disinterest in the world around him. In fact, this general hormonal insufficiency has important implications for almost every part of the body. To recover from Stage Four Adrenal Fatigue requires significant time, patience and often and complete change in lifestyle.

Symptoms of Hyperadrenalism are dizziness, headaches, hot flashes, increased blood pressure, hair growth on face (female), sugar in urine (not diabetes), and masculine tendencies (female). Hypoadrenalism may present with weakness, dizziness from sitting to standing, low blood pressure, chronic fatigue, allergies, hives, salt cravings, and respiratory disorders to name a few. From a functional medicine angle there are a few ways of checking the health of your adrenal glands. Something as simple as a sitting to standing blood pressure to monitor for major drops is a good starting point. Blood work with a cortisol level check in the AM and PM are great too. Saliva cortisol measurements can be used to measure the level all throughout the day and is very accurate. Patients who have a tendency to burn out with their energy in the afternoon tend to have adrenal problems. I commonly see hypoadrenal problems go missed as hypothyroid conditions as they mirror image each other with similar symptoms. More will be covered on this topic in  a future blog. Is your doctor picking up on your adrenal problems?
Dr. J

  1. #1 by Kelly Wyman on July 19, 2016 - 6:27 pm

    Spot on information. I lived this whole
    Process. I am so glad I am finally get to the “other side” of adrenal fatigue. Thanks Dr. J.

    Liked by 1 person

  2. #2 by Deanna kramer on July 19, 2016 - 7:32 pm

    What do you have to do for a saliva cortisol test?? You make complaints and they take blood test and say everything is fine!!


    • #3 by Beth Berry on July 19, 2016 - 8:20 pm

      My stress seems to be a bit different. My sex drive never goes down LOL even if I am stressed, tho it does make me super tired and can’t sleep! Good post!

      Liked by 1 person

    • #4 by Beth on July 19, 2016 - 8:22 pm

      You can just ask your doctor for a saliva cortisol test. It can be used as a bunch of things, abnormal weight gain, weight loss, or just having trouble loosing weight. Those are good ones to use for Doctor and insurance purposes. That’s what I used 😉


    • #5 by Diverse Health Services on July 20, 2016 - 8:34 am

      Genova has a saliva kit for cortisol that i use. And insurance will cover some of the cost as well.


  3. #6 by Bob Sinnamon on August 17, 2016 - 11:46 am

    Hi DHS,]

    Thought I would send this poignant graphic. It is SO sad, it is “humorous”, in a slanted way. What are we coming too! But then again, I guess we know! [😊]

    Lots of love to you all.

    Glenda Sinnamon



    Liked by 1 person

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