Copy of Blog Feature April 2022 - 2

DiagnosTechs Lab Testing for the Adrenal Stress Index (ASI)

Hi, I’m Dr. Marie Starling

We are your Denver, CO Functional Medicine specialists who specialize in adjunctive care for internal disorders, autoimmune conditions, IBS, thyroid symptoms, diabetes, and other complex health issues.

By:  Dr. Caitlin Landerholm, DC

Why we run the Adrenal Stress Index (ASI)

Adrenal related disorders have become an epidemic as we currently live in a high stress society. The adrenal glands adapt to stress (emotional, chemical, physical) by producing steroid hormones cortisol, aldosterone, progesterone, and DHEA; and catecholamines epinephrine and norepinephrine. Dysfunction of the adrenal glands is not due to a problem with the gland, but rather the pathways in the brain that signal the glands to perform their function.  Patients often have symptoms of Adrenal Stress and they take supplements for their adrenals, but they don’t improve. This is because their symptoms are NOT an adrenal gland issue.

We run the ASI to rule in OR rule out Adrenal Stress Syndrome. We often know patients have this based on their symptoms, but we need to know what kind in order to treat it appropriately.

Signs and symptoms of Cortisol Imbalance

  • Fatigue
  • Headaches with physical or mental stress and/or afternoon headaches
  • Slow starter in the morning
  • Crave sweets, salt, caffeine, nicotine
  • Get shaky or light headed if meals are missed or delayed
  • Irritable before meals
  • Eating relieves or worsens fatigue
  • Difficulty falling asleep (adrenal hyperfunction) or staying asleep (adrenal hypofunction)
  • Weak immune system
  • Allergies

About the test

The Adrenal Stress Index panel is a collection of 4 saliva samples during the day. A sample is collected in the morning, noon, afternoon, and evening on the same day. The test measures 4 levels of cortisol, 1 level of DHEA, total secretory IgA, and gliadin antibody SIgA.

Cortisol is secreted in a specific pattern during a 24 hour period. Any alterations in this pattern indicate adrenal stress syndrome. The normal pattern is high levels of cortisol in the morning, which gradually decrease and obtains our lowest levels at midnight. Cortisol has in inverse relationship with melatonin so at night when cortisol levels decrease, melatonin increases to induce sleep.  When we are asleep, our bodies are in a fasting state so cortisol levels rise to maintain our blood sugar to feed brain and blood cells. Usually patients that have adrenal hyperfunction will have spikes in the late evening when cortisol should be low, and those that have adrenal exhaustion will have low cortisol in the morning when it should be high.

What to know before the test

  • It is important for patients to not have adrenal stimulants such as caffeine and nicotine or other substances that may interfere with accurate levels of cortisol such as licorice root or adrenal glandulars. Stimulants such as caffeine and nicotine must be avoided on the day of the test. Herbs that impact adrenal function should be avoided for at least 4 days before the test.
  • The test should be performed during a patient’s average day. For example, the test should not be performed on a day of a stressful event such as running a marathon, or day at the amusement park, or attending a funeral or other emotional event.
  • If the patients is or has been on corticosteroid drugs within 3 months, accurate levels may not be determined.

The Adrenal Response to Stress

The adrenal glands adapt to stress in three stages:

  • Stage 1: Alarm reaction
    • This is the body’s initial response to stress. The adrenal glands to into a hyperfunctional state to increase cortisol to adapt to the demands of stress.
    • Stage 2: Resistance stage
      • This occurs of stress is prolonged. The adrenals will adapt to this stage by going through a process called the “pregnenolone steal.” Pregnenolone is the precursor for cortisol and all the sex hormones. During stress, the body will use pregnenolone to make cortisol to deal with stress instead of DHEA for sex hormones such as estrogen and testosterone.
      • Stage 3: Exhaustion stage
        • This represents a point where the adrenals can no longer adapt to stress and are exhausted.

What we’re looking for

We determine if there is a dysfunction in the:

  1. Quantity of cortisol production controlled by the Hypothalamus-Pituitary-Adrenal (HPA) Axis,
  2. Circadian Rhythm of cortisol and melatonin controlled by the Hippocampus,
  3. Amplitude of the stress response controlled by the Mesencephalic Reticular (Limbic) System.

Symptoms of dysfunction in the Quantity of Cortisol production:

  • Low cortisol: shaky, irritable and jittery if going too long between meals, need to eat every few hours, eating food relieves fatigue and gives energy (Hypoglycemia)
  • High cortisol: weight gain, fatigue after meals, craves sugar, need to eat sweets or have caffeine after lunch (Insulin Resistance)

Symptoms of dysfunction in the Circadian Rhythm of Cortisol and Melatonin:

  • Low cortisol in AM: can’t get out of bed, snoozes alarm multiple times, need coffee or a cigarette in the morning, has to work out in AM in order to function
  • High cortisol in AM: wakes tired, needs excess amounts of sleep, can’t recover from workouts, can’t achieve deep/REM sleep
  • If cortisol doesn’t come down: craves sugar, needs nap after lunch, needs sweets/caffeine after lunch
  • If cortisol drops too quickly: afternoon crash in energy, needs caffeine or sugar
  • Low cortisol in PM: can’t stay asleep
  • High cortisol in PM: can’t fall asleep/insomnia, doesn’t feel rested in the morning

Symptoms of dysfunction in the Amplitude of the stress response:

  • Memory deficits: needs reminders, forgets where keys, phone, and car are located, difficulty learning information, difficulty retaining information
  • Chronic fatigue, can’t sleep at night, chronic blood sugar issues
  • Sensitivity to sound, crowds, and light
  • Balance issues, OCD, can’t calm down the mind

Impacts of Adrenal Stress Syndrome

Cortisol plays a critical role in our physiology and metabolism. Although the adrenal glands aren’t the problem, it’s important that they work. Here’s a list of conditions/processes an imbalance of cortisol directly impacts:

  • Blood Sugar imbalances
  • Thyroid Defects
  • Anterior Pituitary hypofunction
  • Liver Detoxification dysfunction
  • Intestinal dysbiosis and Leaky Gut Syndrome
  • Suppressed Immune System
  • Neurodegenerative disease
  • Cardiovascular disease

More information about DiagnosTech Adrenal Stress Index (ASI) panel can be found at:

Contact The Healing Center Denver today to learn how we can help you!



Grisanti, Ron, DC & Weatherby, Dicken, ND. “Insider’s Guide Adrenal Stress Index Interpretation.” Functional Medicine University. Web. 20 June 2016.

Kharrazian, Datis, DC, MS, FAACP, DACBN, DIBAK, CNS, CCN, CSCS, CCSP. “Functional EndocrinologyAssessment and Nutritional Management.” Apex Energetics. 2004.