Adrenocortex Stress Profile with Cortisol Awakening Response

A Comprehensive Tool to Assess the HPA Axis — Stress Response and Resiliency

The Adrenocortex Stress Profile (ASP) provides an assessment of the Hypothalamic-Pituitary-Adrenal (HPA) axis using carefully timed salivary samples of the hormones cortisol and DHEA. Salivary testing is an easy, non-invasive option to measure unbound, biologically active parent hormone levels. The report offers an easy-to-interpret graphic which plots the results of the cortisol awakening response (CAR) and the natural diurnal rhythm.

Clinicians Have the Following Cortisol Testing Options:

  • Adrenocortex Stress Profile (ASP): Four salivary samples measured throughout the day to give insight into the natural circadian diurnal cortisol rhythm, and help clinicians address specific daily stressors.

  • Cortisol Awakening Response (CAR): Three awakening samples to evaluate CAR with one evening cortisol sample.

    • CAR is a transient, immediate rise in cortisol upon awakening and is distinct from the diurnal rhythm. CAR reflects a person's ability to cope with anticipated challenges and their perception of control around chronic stress, providing insight into HPA axis resiliency.

    • The isolated evening cortisol has distinct clinical implications. Elevated evening cortisol is linked to insomnia and associated with various diseases such as diabetes, cardiovascular disease, hormonally driven cancers, and osteoporosis.

     

  • Adrenocortex Stress Profile with Cortisol Awakening Response (ASP with CAR): Six samples that offers the most comprehensive look at cortisol and the HPA axis.

DHEA is measured once in the 7:00 AM – 9:00 AM sample and a ratio of DHEA to cortisol is calculated to provide insight into anabolic/catabolic balance.

Daily hassles, chronic pain, blood sugar dysregulation, work stressors, and poor relationship quality can alter the HPA axis. Imbalances in adrenal hormones can have a wide range of negative consequences that can adversely impact a patient's overall quality of life. The symptoms of HPA axis dysfunction can be vague and are highly variable but may include: fatigue, insomnia, weight gain, depression, GI complaints, and chronic pain. HPA axis dysfunction is associated with many conditions including:

  • hypertension

  • cardiovascular disease

  • gastrointestinal and immune dysregulation

  • diabetes and metabolic syndrome

  • depression

  • chronic fatigue

  • persistent pain

  • neurodegenerative disease and cognitive decline

Adrenocortex Stress Profile testing can reveal these HPA axis imbalances and provide direction for clinical intervention with targeted therapeutic treatments such as nutrient support and/or adaptogens, stress management, behavioral modification and lifestyle interventions.

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Based on NSA's ongoing commitment to quality assurance, we have updated the calculation for CAR to reflect a direct percentage increase. Most literature demonstrates an expected increase of ≥ 50% (with a range of 50 -150%).

REFERENCES
  1. Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. Journal of psychosomatic research. 2002;53(4):865-871.

  2. Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. IntJPsychophysiol. 2009;72(1):67-73.

  3. Clow A, Hucklebridge F, Stalder T, Evans P, Thorn L. The cortisol awakening response: more than a measure of HPA axis function. NeurosciBiobehavRev. 2010;35(1):97-103.

  4. Hackett RA, Kivimäki M, Kumari M, Steptoe A. Diurnal Cortisol Patterns, Future Diabetes, and Impaired Glucose Metabolism in the Whitehall II Cohort Study. The Journal of Clinical Endocrinology & Metabolism. 2016;101(2):619-625.

  5. Hammer F, Deutschbein T, Marx A, et al. High evening salivary cortisol is an independent predictor of increased mortality risk in patients with systolic heart failure. International journal of cardiology. 2016;203:69-73.

Test Type: Salivary Test

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