Understanding HPA Axis Dysfunction

Understanding HPA Axis Dysfunction

woman who appears stressed stands in front of chalk board with cortisol molecular structure

Stress is a necessary part of our body’s response to the environment. It can alert us to danger and promote excellence under pressure, such as in sports or academics. In other words, a little stress is good for us. Chronic stress, however, is another matter. Prolonged periods of physical and emotional stress can take their toll on the body’s systems, including those that are meant to regulate our body’s stress response in the first place. One of the most important of these systems is the Hypothalamic-Pituitary-Adrenal (HPA) axis. When this axis becomes dysregulated, it can lead to a cascade of physiological and psychological symptoms. Keep reading to learn more about HPA axis dysfunction, symptoms, and strategies to manage it effectively.

What is HPA Axis Dysfunction?

The HPA axis is a vital neuroendocrine system involved in the body’s stress response. It consists of the hypothalamus, pituitary gland, and adrenal glands, collectively working to regulate hormone levels, including cortisol. When the brain perceives a stressor, it signals the hypothalamus to release corticotropin-releasing hormone (CRH), which stimulates the pituitary gland to produce adrenocorticotropic hormone (ACTH). ACTH then prompts the adrenal glands to release cortisol. 

HPA axis dysfunction occurs when this intricate system becomes imbalanced, leading to abnormal cortisol levels and disruption of the body’s ability to manage stress effectively. This dysregulation can manifest in various ways, impacting both physical and mental health (see below for symptoms). 

Although the adrenal glands are only part of the axis, HPA axis dysfunction is sometimes also called “adrenal fatigue.”

Causes of HPA Axis Dysfunction

While chronic stress is a leading cause of HPA axis dysfunction, it is not the only one. In many cases, there may be a combination of factors contributing to adrenal fatigue, including:


Past trauma, such as abuse or neglect, can sensitize the HPA axis, causing a heightened response to perceived stress. 


Some individuals may have a genetic predisposition to HPA axis dysfunction, making them more vulnerable to developing hormonal imbalances.

Poor Sleep

Sleep disturbances or insufficient sleep are associated with elevated cortisol levels in the blood, causing the HPA axis to be hyperactivated. This, along with other negative impacts on the body’s metabolism, are linked to the development of obesity and Type 2 diabetes. 

Nutritional Imbalances

Inadequate nutrition or imbalances in key nutrients, such as magnesium or vitamin C, can impact HPA axis function.Studies have shown, for example, that caloric restriction activates the HPA axis, potentially leading to unhealthy levels of cortisol. 

Chronic Illness

Conditions such as autoimmune diseases, fibromyalgia, or chronic fatigue syndrome are linked with HPA axis dysfunction. Studies are ongoing as to the reason why these illnesses can cause adrenal fatigue, but it is likely that stress and discomfort associated with prolonged disease is a factor. 

Symptoms of HPA Axis Dysfunction

The symptoms of HPA axis dysfunction can vary widely but may include:

  • Fatigue and lethargy
  • Insomnia or disrupted sleep patterns
  • Weight gain or difficulty losing weight
  • Mood swings, anxiety, or depression
  • Thinning hair
  • Sugar/salt cravings
  • Dry skin
  • Joint pain
  • Cognitive difficulties, such as brain fog or memory problems
  • Digestive issues, including irritable bowel syndrome (IBS)
  • Reduced immune function and increased susceptibility to infections
  • Irregular menstrual cycles or hormonal imbalances in women or those assigned female at birth (AFAB). 

Treating HPA Axis Imbalance

Managing HPA axis dysfunction will depend on the root cause of the imbalance. It will likely include a combination of strategies that help regulate cortisol levels and support overall well-being, such as:

Stress Management Techniques: incorporating relaxation techniques such as deep breathing, meditation, yoga, or tai chi can help mitigate the body’s stress response and promote relaxation.

Regular Exercise: engaging in regular, mild-to-moderate physical activity can help reduce cortisol levels and improve mood and sleep quality. On the other hand, if intense physical stress is suspected as a root cause of HPA axis dysfunction, your provider may recommend reducing your exertion levels. 

Healthy Lifestyle Habits: prioritizing adequate sleep, maintaining a balanced diet rich in nutrient-dense foods, and avoiding excessive caffeine and alcohol consumption can support HPA axis function.

Supplementation: some individuals may benefit from targeted supplementation to support HPA axis function. Magnesium and vitamin B complex, for example, have been shown to lessen feelings of stress and anxiety in certain individuals.

Hormone Replacement Therapy: chronic stress is also associated with lower levels of DHEA. If this is suspected, your provider may recommend bioidentical hormone replacement therapy (BHRT) to restore lost DHEA and other affected hormones. 

How is HPA Axis Dysfunction Diagnosed?

If you are experiencing symptoms of HPA Axis Dysfunction, aka adrenal fatigue, you will want to consult with a qualified functional medicine provider. Functional medicine utilizes a holistic approach, which will be integral in achieving long-term relief from your symptoms. Your provider will start by obtaining a thorough medical history from you, followed by a physical exam. He or she may then order blood work or other tests designed to evaluate HPA axis health. 

Treatment for Adrenal Fatigue in Omaha

If you are suffering with symptoms of HPA axis dysfunction in Omaha, Nebraska, please contact the professionals at Balanced Body Health & Wellness. We are a dedicated functional medicine clinic with a passion for education and sustainable wellness practices. You can schedule a free 15-minute discovery to decide if we are right for you; or, visit our online portal to choose a time and date for your full initial consultation. 

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