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Adrenal Stress Index: Seven Stages of Fatigue

By Wendy Melton ; Updated August 14, 2017

The adrenal glands are responsible for the production of many hormones that are necessary for vital functions in the body. They also produce the hormones that are needed for the "fight or flight" response for when the body is under stress. Constant stress can lead to the adrenal glands being overworked to the point of exhaustion. This can lead to diseases such as chronic fatigue and Addison's disease. According to, the Adrenal Stress Index was developed to help diagnose disorders and treat people who are in variable stages of adrenal distress.

Stage 1

In this stage of adrenal insufficiency, cortisol and DHEA remain at normal levels. The adrenal glands are able to handle the stress being placed on the body. Hormone production may be somewhat affected but for the most part, the body is able to produce enough cortisol and DHEA to compensate.

Stage 2

With the body under constant stress, cortisol levels continue to rise. DHEA levels begin to gradually decrease. As the adrenals begun to struggle, symptoms can start to appear. The Mayo Clinic says nervousness, disruptions in sleep patterns, body aches and digestive problems can all be signs that the adrenals are becoming sluggish.

Stage 3

When a person reaches Stage 3, anxiety and exhaustion begin to appear simultaneously. Panic attacks can result from extremely high levels of cortisol in the system. With the level of DHEA continuing to drop, sleeplessness may result. When these two extremes begin to affect day-to-day activities, people usually seek medical treatment, according to

Stage 4

As the body's stored DHEA, begins to be used up, cortisol levels begin to drop. Cortisol levels may taper off and symptoms may seem to leen. The body remains under stress, and resources of cortisol and DHEA are being depleted. A person's energy patterns begin to change. It becomes more difficult to wake up and even harder to fall asleep. Sleep is often disrupted as blood sugar begins to drop.

Stage 5

Stage 5 of adrenal fatigue shows DHEA levels rising, according to Because cortisol production has stalled, very little of the existing DHEA is being used. What little cortisol is available is quickly being used in the effort to handle stress. The body continues to weaken, and little activity is possible.

Stage 6

During this stage, the body tries to stimulate the production of cortisol as DHEA levels rise above normal. Adrenocorticotropic hormone, or ACTH, is not available to fuel the process, so the body continues to weaken. ACTH levels have continually dropped, along with levels of other hormones throughout the body. This is usually the body's final attempt to correct the imbalance.

Stage 7

Stage 7 is rarely seen; it's basic adrenal failure. The adrenals have ceased to function for the most part, and little can be done to restore balance. Most cases are caught and corrected between Stages 2 and 5. According to, it can be difficult to diagnose and correct the problems as they progress. Understanding the symptoms and what is happening during each stage is a key to reversing the process.

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