Adrenal Testing in Adelaide: A Functional Approach to HPA Axis Dysregulation

Author: Rohan Smith | Functional Medicine Practitioner | Adelaide, SA

For patients in Adelaide experiencing the familiar “wired but tired” pattern, standard morning blood cortisol tests often fail to capture the full picture. At Elemental Health and Nutrition, we move beyond the oversimplified and outdated concept of “adrenal fatigue” to assess the Hypothalamic–Pituitary–Adrenal (HPA) axis as a regulated stress-response system.

Understanding how your cortisol rhythm behaves across the day is often the first step toward addressing the biological impact of chronic stress and burnout.

Quick Answer: What Does Adrenal Testing Actually Measure?

Adrenal testing evaluates the pattern, timing, and balance of cortisol and DHEA-S output across a full 24-hour cycle (1,2). Rather than relying on a single blood snapshot, functional adrenal testing—typically via saliva or dried urine—can assess the Cortisol Awakening Response (CAR) and the daily cortisol “slope” (3,15).

This approach can help identify whether the stress system is trending toward hyper-arousal (elevated cortisol), suppression (low cortisol), or circadian dysregulation, allowing nutrient and lifestyle strategies to be aligned with the individual’s physiological pattern rather than applied generically (4,10).

The Science of the HPA Axis and Allostatic Load

The adrenal glands do not simply “burn out.” Instead, prolonged stress exposure can lead the brain—via the hypothalamus and pituitary—to alter adrenal signalling in order to limit the damaging effects of persistently elevated stress hormones. This adaptive process is referred to as allostatic load (5,6).

Because this regulation occurs from the top down, many so-called “adrenal issues” are better understood as brain-to-gland communication shifts rather than primary gland failure. Advanced adrenal testing can provide insight into several key markers:

• The Cortisol Awakening Response (CAR):
  A normal CAR involves a 35–50% rise in cortisol within 30 minutes of waking. A flattened CAR has been consistently associated with burnout, chronic fatigue, and reduced stress resilience (3,11).
• Metabolised Cortisol:
  Indicates how much cortisol the body is producing overall versus how much remains in its free (biologically active) form (7,12).
• DHEA-S Levels:
  An anabolic counter-regulatory hormone that supports immune balance, tissue repair, and stress adaptation during prolonged demand (8,13).

Testing Methods: Saliva vs. DUTCH (Urine)

At our Adelaide clinic, two primary testing methods are used for adrenal assessment:

• Salivary Cortisol Testing:
  Particularly useful for measuring free cortisol and the CAR. This non-invasive approach provides a clear picture of circadian rhythm integrity across the day (1,9).
• DUTCH Testing (Dried Urine):
  A comprehensive assessment using the DUTCH Complete test, which includes cortisol metabolites, organic acids, and sex hormone balance. This method offers insight into overall cortisol production, clearance, and downstream metabolic effects (7,14).

The Functional Medicine Edge: Beyond Stress Management

From a functional medicine perspective, adrenal findings are rarely viewed in isolation. When cortisol regulation is disrupted, we also assess for underlying stress amplifiers, including:

• Neuro-inflammation:
  Often explored alongside organic acid testing to identify metabolic or neurotransmitter stress patterns.
• Blood Sugar Dysregulation:
  Cortisol plays a central role in glucose regulation. Diets high in refined carbohydrates can repeatedly activate the HPA axis in an attempt to stabilise blood sugar levels (4,8).
• Gut Health Stressors:
  Increased intestinal permeability and endotoxin exposure may keep the stress response system in a heightened state of alert (14,15).

Frequently Asked Questions

Why did my GP’s blood test show “normal” cortisol?

Blood tests measure total cortisol at a single moment and are designed to detect overt endocrine disease such as Addison’s or Cushing’s. They are not intended to assess circadian rhythm or functional stress regulation (1,5).

Can supplements alone fix adrenal issues?

Nutrients such as vitamin C, vitamin B5, and specific adaptogenic herbs can be supportive, but their effects depend on the underlying cortisol pattern. When mismatched, some interventions may worsen symptoms such as insomnia or daytime fatigue (10,13).

How long does HPA axis recovery take?

Physiological recovery often occurs over several months—commonly in the range of 3 to 9 months—depending on severity, duration of stress exposure, and how effectively contributing lifestyle factors are addressed (2,11).

Key Insights

• Most adrenal concerns reflect HPA axis dysregulation, not adrenal gland failure (1,10).
• The Cortisol Awakening Response is one of the most reliable markers of stress system resilience (3,11).
• Differentiating free versus metabolised cortisol is essential for accurate interpretation (7,14).
• Recovery often overlaps with broader support for chronic fatigue and burnout and circadian rhythm restoration (4,15).

Regain Your Vitality Today

Burnout and chronic fatigue do not have to become permanent states. At Elemental Health and Nutrition, we provide advanced adrenal testing and clinical interpretation to support stress system recovery and long-term resilience.

If you are seeking advanced adrenal testing or functional support for chronic fatigue in Adelaide, I am here to guide your next steps.
Book your adrenal consultation today.

References

1. Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009.
2. Chrousos GP. Stress and disorders of the stress system. Nature Reviews Endocrinology. 2009.
3. Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. Psychoneuroendocrinology. 2009.
4. Epel ES, Lapidus R, McEwen B, Brownell KD. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2000.
5. McEwen BS. Protective and damaging effects of stress mediators. New England Journal of Medicine. 1998.
6. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews. 2010.
7. Newman M, et al. Evaluating urinary cortisol and its metabolites using dried urine testing. BMC Endocrine Disorders. 2016.
8. Kirschbaum C, Hellhammer DH. Salivary cortisol in psychobiological research: an overview. Neuropsychobiology. 1994.
9. Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. 2009.
10. Head KA, Kelly GS. Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Alternative Medicine Review. 2009.
11. Powell DJ, Schlotz W, et al. The cortisol awakening response, chronic stress and health: a systematic review. Health Psychology Review. 2013.
12. Guilliams TG, Edwards L. The Role of the HPA Axis in Chronic Fatigue. 2010.
13. Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals. 2010.
14. Sudo N, et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. The Journal of Physiology. 2004.
15. Mücke M, et al. Adrenal Fatigue: Does it exist? A systematic review. BMC Endocrine Disorders. 2018.