만성피로 및 에너지 항상성에 대한 부신 호르몬 관점에서의 접근

Abstract

The health paradigm has been ruling things out except diseases and taken a passive, wait and see approach. However, the future paradigm of medicine should use the concepts of rule in and disease prevention. The adrenal glands produce many hormones including cortisol and dehydroepiandrosterone (DHEA) which is play an important role in energy and immune modulation, ultimately stress adaptation. Adrenocorticotropic hormone, an important component of the hypothalamic-pituitary-adrenal axis, is the last hormone to stop working in pituitary gland. The biological reserve for adrenal glands needs minimum 10 percent to rule out histopathological diseases. Therefore, the disease category in adrenal glands is limited, albeit their crucial role for daily life, such as Addison’s disease and secondary adrenal insufficiency, especially in perspective of stress adaptation. After exclusion of adrenal diseases, we can perform some laboratory tests to evaluate functional and dynamic status for adrenal hormones, and do a three-dimensional examination: 1) One day evaluation for diurnal variation of cortisol in context of individual lifestyle, 2) Serial evaluation for cortisol, pregnenolone, DHEA and adrenal status, 3) Cross-sectional staging for adrenal status according to cortisol and DHEA levels. Based on the functional estimations for adrenal status, individualized management should be done: Lifestyle modification, therapeutic diet education, supplementation, and medication if necessary. Bridging the gap between conventional approach and functional approach for chronic fatigue may be helpful for enhancing health and quality of life. In upcoming super-aging society, the importance of functional fatigue status would be more noticed and multidisplinary approach should be actively performed.