David L. Hoffmann BSc Hons MNIMHAlternative medicine abounds in ideas about and remedies for the adrenal glands. Unfortunately they are often just an expression of a fundamental lack of knowledge about the adrenals. The ideas couched in these terms are often valid and helpful, but invoking some adrenal tonic’ effect must be based upon actual physiology and not pseudo-science.
The two adrenals sit astride each kidney, deep in the back part of the abdomen. However, it is vital to recognize that each of these glands has two parts, a cortex or outer part, and a medulla or central portion. These have markedly different functions. When therapy is directed towards these glands, it must be appropriate to the adrenal function the practitioner wants to address.
Adrenal Medulla
The adrenal medulla secretes the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine), responsible for the rapid increases in nervous system and metabolic activity involved in the stress response. Summarizing the effects of these two hormones
Adrenaline (epinephrine)
- Acts on [alpha] and [beta] receptors.
- Increases contractility & excitability of heart muscle, thus increasing cardiac output.
- Facilitates blood flow to muscles, brain, and viscera.
- Enhances blood sugar levels by stimulating conversion of glycogen to glucose in liver.
- Inhibits smooth muscle contraction.
Noradrenalin (norepinephrine)
- Acts primarily on [alpha] receptors.
- Increases peripheral vascular resistance, leading to increased blood pressure.
For a discussion of the contribution that can made by herbs in support of the adrenal medulla when under stress, please refer to the section on Stress and the General Adaptation Syndrome. Adaptogens are the core of this support, with saponins such as the eleuthero sides directly impacting the medulla. Nervine tonic support of some kind is usually indicated as well, although this does not directly impact the medulla. The contribution from such nervines is a more generalized systemic support that eases the impact of tension and anxiety. Bitter tonics can be helpful as well. Examples might include
Adaptogens: Panax spp.(Ginseng ), Eleutherococcus senticosus (Siberian Ginseng)
Nervine Tonics: Scutellaria later if olia (Scullcap), Hypericum perforatum (St. John’s Wort), Avena sativa (Oats)
Adrenal Cortex
The cortex is responsible for production of glucocorticoids, such as cortisol, which have a regulatory effects on metabolism, the immune system, certain aspects of behavior, and many other processes. The cortex also secretes aldosterone, fundamental to the homeostatic control of sodium and potassium secretion by the kidney. These hormones are synthesized from cholesterol.
Glucocorticoids (cortisone and hydrocortisone)
- Enhance protein catabolism and inhibit protein synthesis.
- Antagonize action of insulin.
- Increase synthesis of glucose by liver.
- Influence defense mechanism of body and its reaction to stress.
- Influence emotions.
Mineralocorticoids (aldosterone, desoxycorticosterone)
- Regulate re-absorption of sodium cation.
- Regulate excretion of potassium cation by renal tubules.
Adrenosterones (adrenal androgens)
Herbal medicines can impact the adrenal cortex in a variety of ways. Most important is the direct effect of plants rich in a specific variety of saponin such as Glycyrrhiza glabra (Liquorice). Borage (Borago offici nalis),
Whilst the cortex and medulla produce different hormones in response to differing stimuli, they share a complex role in some situations, for example the stress response. As has been described in the section on stress, the immediate response is controlled mainly, though not completely, by the adrenal gland’s central medulla, while long-term response is handled by the surrounding cortex. The initial response-preparing the body for what has been called the fight-or-flight reaction-involves:
1. Increased nervous-system activity.
2. Release of adrenaline and/or noradrenalin into the blood stream by the adrenal medulla. These hormones support the nervous system through metabolic activity. The body’s response to these chemicals includes:
- increase in heart rate and blood pressure.
- surface constriction of blood vessels, so that the blood leaves the skin to provide the muscles with more sugar and oxygen (which is why we go white with shock).
- mobilization of the liver’s energy reserves through the release of stored glucose.
If the stressful situation is very intense or continues over a period of time, the adrenal cortex becomes increasingly involved in the stress reaction. The activity of the cortex is largely controlled by blood levels of adrenocorticotrophichormone (ACTH), which is released by the anterior pituitary gland. When information about sustained stress has been processed by the central nervous system, a whole range of new bodily responses occurs, and it is these longer-term reactions that can adversely affect the quality of life.
Herbs for the Adrenal Medulla
Adaptogens are the core of adrenal medulla support, with saponins such as the eleuthero sides directly impacting the medulla. Nervine tonic support of some kind is usually indicated as well, although this does not directly impact the medulla. The contribution from such nervines is a more generalized systemic support that eases the impact of tension and anxiety. Bitter to nicscan be helpful as well. Examples might include
Adaptogens: Panax spp.(Ginseng ), Eleutherococcus senticosus (Siberian Ginseng)
Nervine Tonics: Scutellaria laterifolia (Scullcap), Hypericum perforatum (St. John’s Wort), Avena sativa (Oats)
Herbs for the Adrenal Cortex
Herbal medicines can impact the adrenal cortex in a variety of ways. Most important is the direct effect of plants rich in a specific variety of saponin such as Glycyrrhiza glabra (Liquorice). Glycyrrhiza is proving to be a controversial remedy because of its effects upon the adrenal cortex. Aldosterone is part of what has been called the renin-aldosterone-angiotensin axis, a hormonal homeostatic complex that regulates electrolyte balance in the blood and volume of urine passed. When Glycyrrhiza is eaten or taken in great excess it has a direct impact upon aldosterone leading to potassium depletion. This is a very rare occurrence, but the pharmacology books make a big point of it, to demonstrate the dangers of herbal medicine. On the other hand there are well known cases in Britain of people with addisons disease benefiting greatly from this herb. Thus in overactive conditions Glycyrrhiza should be avoided but in under active it is indicated.
As discussed briefly above, the adaptogens will support the cortex in its response to ACTH.
Cushing’s Syndrome
This entity is caused by excessive cortisol, and derives from either excess ACTH from the pituitary, excess production from the adrenal itself, or the use of the cortisone-like steroid drugs. This last cause is all too common.
Adrenal Insufficiency
When both adrenal glands are largely destroyed by lack of circulation during shock or hemorrhage, by infection with tuberculosis or other diseases, by hemorrhage directly into the glands, or by a poorly understood autoimmune disorder, adrenal insufficiency is said to occur. Other causes are less common.
The lack of cortisol leads to increased stimulation by the pituitary in the form of ACTH production. This hormone in excess causes darkening of the skin, one of the early symptoms of adrenal insufficiency. Other symptoms include weight loss, weakness, loss of appetite and energy, and low blood pressure. With any physiologic stress, total decompensation can occur with shock, major chemical imbalances in body chemicals, and death. This emphasizes the importance of cortisone in the body’s reaction to stress.
The commonest cause of adrenal insufficiency is the medical use of prednisone or other cortisone-like drugs. When administered for more than two weeks, the drug suppresses the body’s own cortisone production which then goes into abeyance for a long time. When the drug is discontinued after prolonged use, months may be required for the body to restore its own production. During this interval adrenal insufficiency may be present, and under stress a true emergency may arise. It is for this reason that such doses are tapered off slowly.
Side Effects of Steroid Therapy considered acceptable and expected by the prescriber /(though not by the patient!)
Nature of Effect Action
Facial mooning (Cushing’s syndrome) May be minimized by restricted calorie intake.Weight gain: Restrict calorie intake; may require a change in steroid medication: may require a diuretic.
Edema: May require diuretics and potassium.
Potassium loss: Use potassium supplement.
Acne: Treat with topical medications.
Urinary frequency and nocturia: Check for evidence of genitourinary infection or diabetes mellitus; urinalysis
Insomnia, headache, fatigue, euphoria. Treat symptomatically.
Side Effects of Steroid Therapy – considered undesirable and dangerous by the prescriber,
Nature of Effect Action
Allergic reaction to ACTH or steroid: Withdraw drug promptly. Substitute steroid or synthetic ACTH.Cardiovascular system effects
- Hypertension: Suggest reduction in dosage of steroids.
Thromboembolic complications
- Arthritis
Infection: Suggest anti-microbial medications as indicated.Eye complications:
- Glaucoma – refer to ophthalmologist.
- Corneal lesions
- Subcapsular cataract
Musculoskeletal effects:
- Osteoporosis
- Pathologic fractures
- Growth suppression
- Myopathies
Central nervous system
- Seizures: refer to neurologist.
- Neuritis
- Psychotic reactions
- Adrenal insufficiency (after steroid withdrawal)
Jim Strohecker
Daniel Redwood DC
Tom Ferguson MD