Adrenal Stress Index: Provider Overview
Clinical Applications of the Adrenal Stress Index (ASI)
Sleep disorders are a very common concern among patients. Disordered circadian rhythmicity
can be a significant contributing factor to sleep difficulties. The Adrenal Stress Index (ASI)
measures cortisol levels throughout the day and evening which can help to identify these
abnormal patterns. Identification of aberrant circadian rhythms can be key to proper
understanding and subsequent treatment of sleep difficulties.
Chronic elevations in cortisol (often due to prolonged stress) increase blood glucose by
increasing the rate of gluconeogenesis in the liver. Recurring exposure to high cortisol may
potentially lead to insulin resistance. The ASI panel investigates the insulin-cortisol
relationship under real-life conditions to allow targeted and effective interventions. This
panel may be useful in many clinical situations including: rapid weight gain or obesity,
abnormal blood lipid levels, muscle wasting, early diabetes, and associated symptoms.
Allergies & Autoimmune Disorders
More than fifty years ago, it was noted that patients with environmentally-triggered
allergies and autoimmune diseases dramatically improved when given cortisol for other
purposes. By providing information about dynamic cortisol levels, the ASI may help to
identify patients with autoimmune diseases and adrenal problems who may beneﬁt from cortisol
The ASI can be a useful tool for evaluating patients with many different medical
conditions. Many publications describe a hyperactive HPA axis in depressed patients.
Elevated salivary cortisol can be an important screening tool for Cushing's syndrome and
Cushing's disease. In Addison's disease, abnormally low levels of cortisol are produced.
Other cortisol abnormalities have been correlated with attention deficit hyperactivity
disorder (ADHD). Anomalous cortisol findings such as these, as well as those frequently
seen in depression, can be identified with the ASI.