From Stress to Stillness: Why “Adrenal Dysfunction” Is More Than Burnout

A New Look at the Stress System

A new review by Dr. Melinda Ring from Northwestern University — “An Integrative Approach to HPA Axis Dysfunction: From Recognition to Recovery” (The American Journal of Medicine, 2025) — shines much-needed light on a problem millions quietly struggle with: fatigue, sleep disruption, mood swings, and poor stress tolerance that don’t fit neatly into conventional diagnoses.

Rather than using the misleading term “adrenal fatigue,” the paper calls it what it truly is — hypothalamic–pituitary–adrenal (HPA) axis dysfunction — a stress-response imbalance that affects hormones, metabolism, and immune function.

It explains how chronic stress, poor sleep, inflammation, toxins, and nutritional deficiencies can desynchronize our natural cortisol rhythm, and it offers practical ways to restore balance through sleep hygiene, mindfulness, nutrition, and adaptogenic herbs.

It’s an excellent synthesis — comprehensive, compassionate, and evidence-based.

But one key question remains unanswered:

👉 Why does the adrenal system get stuck in the first place?

The Missing Layer: What Drives Relentless Adrenal Activation

The HPA axis isn’t broken — it’s doing its job too well, for too long.

Cortisol rises to help us cope with challenges. But when the “all clear” never arrives, the system can’t shut off.

The review focuses on how to calm the system after it’s dysregulated, but not on the upstream triggers that keep it chronically engaged — the unresolved inputs that tell the body it’s still in danger.

In the ERM (Exposure-Related Malnutrition) framework, these upstream triggers fall into four main domains:

1. Metabolic Overload – when the body constantly manages oversupply (glucose spikes, excess lipids) or undersupply (nutrient deficiencies), it keeps cortisol high to stabilize the internal environment.

2. Chronic Exposure Signals – toxins, infections, circadian disruption, and emotional stress act as persistent “background alarms” that the brain cannot tune out.

3. Bioenergetic Depletion – when mitochondria can’t fully recharge between stress episodes, recovery stalls; cortisol becomes a crutch instead of a rhythm.

4. Neural Bias – sustained amygdalar activity (the brain’s threat detector) keeps signaling “prepare for impact,” even in safety.

These are the root causes that precede adrenal dysfunction — the energy, exposure, and recovery imbalance that prevents the HPA axis from completing its natural cycle.

The Natural Rhythm of Stress: Respond → Adapt → Recover

A healthy stress response isn’t about staying calm all the time.

It’s about cycling through three essential phases:

1. Respond: the body mobilizes energy — cortisol rises, heart rate quickens, and the brain sharpens.

2. Adapt: feedback signals slow the system as the threat passes; inflammation cools, and hormones rebalance.

3. Recover: energy is replenished, cells repair, and cortisol returns to its natural circadian pattern.

When the recovery phase is shortened or skipped, the body remains “half-on.”This unsuccessful recovery becomes the seed of chronic fatigue, anxiety, insomnia, and hormonal imbalance.

Over time, the body compensates by down-regulating its stress machinery — what we clinically label as “HPA axis dysfunction.”

A Systematic Way Forward

To truly heal adrenal dysfunction, we need to work both upstream and downstream:

Level	Focus	Example Actions
Upstream – Resolve the Triggers	Identify and remove chronic stress signals.	Detoxify exposures, stabilize blood sugar, optimize circadian light–dark cycle, address infections or inflammation.
Midstream – Restore Bioenergetic Capacity	Rebuild metabolic flexibility and mitochondrial recovery.	Personalized nutrition, structured fasting–feeding rhythm, adequate protein and micronutrients, restorative sleep.
Downstream – Rebalance the HPA Response	Guide the stress system back into rhythm.	Mindfulness, CBT, gentle exercise, adaptogens (ashwagandha, rhodiola), supportive relationships.

Healing doesn’t come from “boosting the adrenals.”

It comes from restoring the rhythm — respond, adapt, recover — and ensuring the body has the energy and safety cues to complete that cycle.

The Takeaway

Dr. Ring’s review is an important reminder that stress is both a biological and emotional event.

But to prevent adrenal dysfunction from recurring, we must go further upstream — to the exposures, mismatched energy flows, and unresolved stress signals that keep the HPA axis trapped in overdrive.

The ERM framework expands the conversation from “How do we calm cortisol? ”

to “Why does recovery keep failing?”

Because resilience isn’t the absence of stress —it’s the capacity to complete the cycle and return home to balance.

Ring, M. (2025). An integrative approach to HPA axis dysfunction: From recognition to recovery. The American Journal of Medicine, 138(10), 1451–1463. https://doi.org/10.1016/j.amjmed.2025.05.044