Nervous System Stress

HPA Axis Dysfunction Symptoms (and What You Can Do) 

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Fatigue, difficulty falling asleep, brain fog, dizziness, nausea, loss of appetite, low blood pressure, increased sugar and/or salt cravings, and unintentional weight gain or weight loss. These are just some of the many potential symptoms of HPA axis dysfunction. 

What is HPA axis dysfunction? Or even the HPA axis itself? 

Before I answer that, first let me ask you another question: Have you ever heard of evolutionary mismatch or mismatch theory? It is one of the central themes of evolutionary biology and medicine and it refers to the profound mismatch between our genes and the modern environment. Our diet is a good and well-known example of this mismatch, but so is our stress-response system, which is primarily governed by the HPA axis (source). 

In an earlier article, I already explained what the HPA axis is. I would recommend reading that one first if the words “HPA axis” currently sound like gibberish to you. In this article, however, I would like to focus on a specific type of HPA axis, namely the dysfunctional one. 

Understanding what HPA axis dysfunction is and being able to recognize its symptoms will allow you to not only put a stop to chronic stress but will also greatly enhance your overall health and wellness. 

Read more: The HPA axis explained >> 

What is HPA axis dysfunction? 

HPA axis dysfunction occurs when the three organs of the HPA axis are not communicating or functioning well, causing us to experience abnormal cortisol levels and/or irregular circadian rhythm. 

Why is it important to recognize the symptoms of HPA axis dysfunction? 

HPA axis dysregulation – when cortisol production and breakdown are not regulated correctly -, can lead to a plethora of health issues, such as: 

  • hypercortisolism or Cushing’s syndrome (excess levels of cortisol) 
  • hypocortisolism or Addison’s disease (insufficient levels of cortisol) 
  • some form of diurnal or circadian dysrhythmia (due to too little cortisol in the morning or too much at night) 
  • unwanted changes in the production of other hormones and neurotransmitters 

The different types of HPA axis-related symptoms 

HPA axis dysregulation and dysfunction 

Symptoms of HPA axis dysregulation and dysfunction: 

  • exhaustion and fatigue 
  • difficulty falling asleep 
  • struggling upon waking up 
  • brain fog 
  • dizziness 
  • nausea 
  • substance dependency (caffeine, alcohol, nicotine, etc.) 
  • low blood pressure 
  • low appetite 
  • increased sugar and/or salt cravings 
  • unexplained weight gain or weight loss 
  • unexplained hair loss 

Hypercortisolism or Cushing’s syndrome 

Hypercortisolism is a rare hormonal disorder that occurs when your adrenal glands produce too much cortisol. It is sometimes caused by taking corticosteroid medication or injections, but it can also develop from your body’s own overproduction. 

Common symptoms of hypercortisolism: 

  • severe fatigue 
  • muscle weakness 
  • weight gain 
  • fatty tissue deposits 
  • pink or purple stretch marks 
  • thinning, fragile skin that bruises easily 
  • slow healing of cuts, insect bites, and infections 
  • acne 

Hypocortisolism or Addison’s disease 

Hypocortisolism, also called adrenal insufficiency, is a rare disorder of the adrenal glands that is caused when your adrenal glands produce too little cortisol or aldosterone. Unless someone experiences an addisonian crisis, also called acute adrenal insufficiency, the symptoms usually develop slowly and it can take several months before they fully show up. 

Besides your body’s own underproduction, hypocortisolism can also be caused by HPA axis suppression. This can be brought on by abrupt withdrawal from chronic steroid use, such as glucocorticoids, for example, and it creates an impaired stress response due to reduced cortisol response. 

Common symptoms of hypocortisolism: 

  • extreme and long-lasting fatigue 
  • unintentional weight loss and loss of appetite 
  • salt cravings (due to salt loss) 
  • hyperpigmentation (or darkening of your skin) 
  • low blood pressure, even fainting 
  • low blood sugar 
  • abdominal pain 
  • muscle or joint pains 
  • nausea, diarrhea or vomiting (gastrointestinal symptoms) 
  • irritability 
  • depression 

Diurnal or circadian dysrhythmia 

Diurnal or circadian dysrhythmia can be caused by a number of things, including shift work, time zone changes, changes in routine, pregnancy, and medications and it often relates to irregular cortisol secretion. 

Like many other physiological processes in the body, cortisol production has a circadian rhythm. It is usually at its peak in the morning, gradually declines over the course of the day, and climbs up again while we sleep. 

However, each time we experience stress, and thus activate our HPA axis, a surge of cortisol is created. This greatly disrupts this flow and overrides our natural circadian pattern. 

Specific symptoms of diurnal or circadian dysrhythmia: 

  • problems falling asleep 
  • frequently waking up during the night 
  • waking up too early and not being able to go back to sleep 
  • getting enough sleep but still not feeling refreshed 

HPA axis dysfunction anxiety 

The HPA axis and anxiety are closely related and while changes in the HPA axis have a significant role in the onset of anxiety, anxiety itself also activates the HPA axis (source). 

This in contrast with panic attacks, which have little effect on the HPA axis, but rather cause major sympathetic activation (SNS). This can be explained by the fact that panic and anxiety are different emotional states that engender different hormonal responses (source). 


The HPA axis’ primary role is to maintain physiological balance or homeostasis, and if it fails to do so, you experience HPA axis dysfunction. 

In this case, your HPA axis is not functioning normally and cortisol production and breakdown are not regulated correctly, which can lead to a plethora of health issues. Being able to recognize the symptoms in time allows you to prevent them from worsening and offers you a chance to restore homeostasis. 

Sound therapy, mindfulness, and yoga are some examples of great stress-relieving methods that also help you to relax and sleep. These relaxing aids are particularly useful for those who suffer from circadian dysrhythmia as it gives them the chance to reset and reprogram their internal body clock. 

Would you like to stimulate recovery from chronic stress and restore homeostasis to your HPA axis? Then take a look at this article where I discuss this topic in more detail, or try the Sonic Relaxation Mini-Course so that you can learn how to release stress by relaxing the body and quieting the mind. You too deserve a balanced HPA axis! 

article by Eline Stone

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