The key stress hormones secreted by our adrenal glands are cortisol, epinephrine and norepinephrine. DM6 Health can assess each of these by creating a diurnal curve (or four-point curve, or circadian pattern), achieved by taking four daily collections – typically done upon waking, before lunch, before dinner and before bed.

Like our adrenal glands, which operate on a diurnal cortisol curve, melatonin also has a diurnal pattern. A normal curve shows melatonin rising during the night to peak during the early hours of the morning – generally 2am to 3am. Levels then drop with the onset of daylight and remain low throughout the day.

The hypothalamic-pituitary-adrenal axis (HPA axis) is a complex set of interactions among these three endocrine glands that affect many bodily functions, including our response to stress. Health care providers are leaning away from the use of terms like “adrenal fatigue” and “adrenal exhaustion” to describe chronic stress conditions, turning instead to the more accurate and medically appropriate term HPA axis dysfunction to describe the many negative conditions related to the stress response

The cortisol awakening response – also called CAR – reveals more detailed clues that help in assessing adrenal hormone dysfunction. During a normal cortisol awakening response, adrenal hormone levels should increase 50% in the first 30 minutes after waking for the day and then begin to progressively drop through the afternoon and evening.