The New Adrenal Stress Index™
The Adrenal Stress Index™ panel (ASI™) was introduced in 1989 to evaluate stress, a leading cause of morbidity and mortality. Recently, new tests were added to evaluate glycemic control using multiple salivary insulin measurements, and evaluate adrenal capacity to produce cortisol using 17-Hydroxyprogesterone. Tests included in the panel are shown in Table 1.

A salivary assay of cortisol and DHEA, imbalances of which are associated with ailments ranging from obesity and menstrual disorders to immune deficiency and increased risk of cardiovascular disease.

A powerful and precise non-invasive assay,evaluates bioactive levels of the body's important stress hormones, cortisol and DHEA. This profile serves as a critical tool for uncovering biochemical imbalances that can underly anxiety, chronic fatigue, obesity, diabetes and a host of other clinical conditions. It's also a crucial tool for monitoring DHEA and/or cortisone therapy.

Changing amounts of DHEA and cortisol over an individual's lifetime may signal important alterations in adrenal function that can profoundly affect his/her energy levels, emotional state, disease resistance, and general sense of well-being. That's because adrenal hormones exert a profound influence on the body's carbohydrate, protein, and lipid metabolism, immune response, thyroid function, cardiovascular health, and overall resistance to stress.

The The New Adrenal Stress Index accurately measures unbound levels of both cortisol and DHEA, and provides a complete circadian analysis of cortisol activity. Controlled collection times allow for accurate baseline testing and effective monitoring of hormone replacement therapy. Saliva samples can be easily collected by the patient at home or at work.

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Therapeutic value: The test results facilitate the diagnosis of stress maladaptation and adrenal fatigue. With this data, you can narrow your choices to the most appropriate modalities of treatment.

DHEA(S):
Description: The panel measures the average DHEA(S)* level for the day using multiple samples.

Therapeutic value: The cortisol to DHEA relationship is presented in a visual graph that highlights the degree of stress maladaptation. This information helps determine the projected time for recovery, and the substances (hormones, supplements, botanicals) that promote this recovery. Cortisol to DHEA ratio regulates many functions as listed below.


* Salivary DHEA(S) is found at about 0.1% of its plasma concentration. Serum fluctuations in DHEA(S) concentrations are accurately and rapidly reflected in salivary levels (3). DHEA(S) indicates Free Fractions of both DHEA & DHEA-Sulfate.

17-Hydroxyprogesterone (17-OHP1):
Description: The panel measures 17-OHP1 level in order to evaluate efficiency of conversion of adrenal precursors into cortisol. Certain adrenal fatigue patients who are genetically predisposed to low production of cortisol will not benefit from exogenous supplementation of pregnenolone or progesterone.

Therapeutic value: By identifying the sub-population of maladapted and adrenal fatigued individuals who show impaired 17-OHP1 conversion to cortisol, two things are avoided:

1. Treating these patients with precursors (when instead they need cortisol supplements to restore their adrenal health).
2. Pursuing further pituitary related tests and treatments (when they are not needed in this subpopulation).

Insulin:
Description: The panel includes fasting and postprandial insulin measurements. The insulin values are used to diagnose insulin resistance, functional insulin deficit (Pre-Diabetes) and also correlate elevated cortisol with insulin to help explain glycemic dysregulation problems. (See Glycemic Dysregulation section)

Therapeutic value: The combined results of insulin and cortisol can help in designing an effective glycemic control treatment plan that may include life style modifications, nutritional support and botanical supplementation.

Secretory IgA (SIgA):
Description: The panel evaluates mucosal immunity by using SIgA as a stress impact biomarker. SIgA values are sensitive to increased cortisol/DHEA ratio and sympathetic tone (See Diagram 2).

Therapeutic value: By detecting depressed mucosal immune function in certain patients, a number of therapeutic modalities may be invoked, ranging from botanical supplementation to control of heart rhythm variability.

Gliadin Antibodies:
Description: The panel includes a gliadin antibody measurement that allows detection of subclinical grain intolerance in affected individuals, even in the absence of overt celiac disease.

Therapeutic value: This test allows objective identification of grain intolerant patients, who should restrict their gluten intake to reduce inflammation and adrenal stress.

Common Adrenal Related Symptom
Inadequate Adrenal Function-
Weight Loss / Anorexia
Progressive Fatigue / Lethargy
Hypoglycemia
Diffuse Muscle & Joint Pains
Hypercalcemia
Low Serum Sodium / Salt Cravings
Skin Hyperpigmentation
High Serum Potassium
Anemia / Lymphocytosis
Lightheadedness upon standing
Abdominal Pain / Diarrhea

Hyperactive Adrenals-
Weight gain / Truncal Obesity
Emotional Lability / Depression
Glucose Intolerance
Ins sulin Resistance
Osteopenia / Fractures
Hypertension / Sodium Retention
Thin hyper pigmented skin / Striae
Sleep Disturbance
Poor Concentration / Memory Loss
Menstrual Dysfunction / Impotence
Increased Blood Lipids

Clinical Applications of the ASI™ Test by Diagnos Tech
Chronic Pain/Fibromyalgia: An adequate adrenal response can maintain a higher pain threshold (4). The ASI™ is used to evaluate the stress impact of chronic pain and inflammation on adrenal adaptation. A proper diagnosis of low cortisol or DHEA with circadian rhythm disruption is imperative. Subsequent hormone replacement and rhythm correction will improve the individual's pain tolerance (7, 8).
Chronic Fatigue syndrome (CFS): A common HPA axis defect in CFS is impaired corticotrophin release (5). As a result low cortisol and eventual adrenal atrophy may be observed. Depleted adrenals with flat rhythms are often seen on the ASI™ panel (6). Simultaneous use of several therapies can help improve the debilitating CFS.

Glycemic Dysregulation: Chronic hypoglycemia can impair normal adrenal function by repetitive over-stimulation of cortisol production. Recurring expo- sure to high cortisol will impair insulin activity, and invariably lead to insulin resistance and beta-cell exhaustion (Diabetes). The ASI™ panel investigates the Insulin-Cortisol relationship under real life conditions to allow targeted and meaningful interventions. This panel is useful in the following clinical situations: rapid weight gain and obesity, deranged blood lipids, sugar blues, early diabetes and associated emotional disturbances.
Allergies/Autoimmune Disorders: Fifty years ago, Dr W. Jefferies (Author of "Safe Uses of Cortisol") discovered that patients with environmentally triggered allergies and autoimmune diseases dramatically benefited when given cortisol for other purposes (9). More recently, German researchers reported that disruption of the adrenal axis and cytokine relationships lead to predisposition and aggravation of autoimmune diseases (10). The findings of the ASI™ help identify patients with autoimmune diseases and adrenal problems who can benefit from cortisol supplements.

Depression/ADD: Several recent publications (11, 12) report a hyperactive HPA axis in depressed patients. Elevated midnight salivary cortisol is now considered one of the best tests in diagnosing endogenous depression. Other anomalies in cortisol rhythm usually accompany the midnight elevation. On the other hand cortisol elevations and rhythm disruptions throughout the day are typical of attention deficit disorders (ADD). The anomalous cortisol findings in depression and ADD can be successfully diagnosed with the ASI.™ Subsequent interventions to rectify the time specific cortisol elevations (during day or night) are usually effective when applied under proper supervision (13, 14).

All lab tests can be done through the mail in the privacy of your own home, except blood tests, we send you to a lab to have your blood drawn for these. After you pay for the test we mail you the kit, the results take two weeks, the test results will be mailed to us and we will call you to go over the results, its that easy! All tests include the consultation for the report of findings.Click on test of interest on the right for more information.

Call our office for more details: 800-956-7083 OR 818-707-3126.