What if adrenal insufficiency symptoms start long before anyone recognizes them?

In this episode, Noah and Eloise explore Rick Disler’s book Adrenal Insufficiency: The Symptoms No One Taught You to See and the powerful idea that adrenal insufficiency is often missed because medicine is trained to look for crisis — not the quieter physiologic instability that comes before it.

Rick Disler, founder of My Adrenal Life, describes cortisol as far more than a “stress hormone.” It is a core survival hormone that helps regulate blood pressure, stabilize blood sugar, support brain function, and help the body recover from stress. When cortisol becomes insufficient, the body doesn’t shut down immediately. Instead, it struggles to compensate.

The episode explains how the body often relies on adrenaline and autonomic overdrive to stay functional. These compensations can produce symptoms that look psychiatric, cardiac, neurological, or gastrointestinal instead of endocrine, which is why adrenal insufficiency so often hides in plain sight.

Noah and Eloise discuss how many patients experience years of symptoms before diagnosis, including:

• episodic exhaustion or collapse
• dizziness and blood pressure instability
• brain fog and slowed thinking
• nausea or abdominal pain
• sensory overwhelm
• post-exertional crashes after normal activity

The conversation highlights one of the book’s key ideas: fatigue in adrenal insufficiency is not normal tiredness. Rick Disler describes it as physiologic energy failure, where the body simply cannot generate or sustain energy when cortisol is insufficient.

The episode also explores why adrenal crisis rarely begins as a sudden event. Instead, it often develops as a gradual slide toward instability, with warning signs that can include worsening fatigue, nausea, dizziness, shaking, or cognitive difficulty.

Another important theme is the role of caregivers. The book emphasizes that caregivers often recognize deterioration before clinicians do, becoming advocates and first responders in a system that may not recognize the condition quickly enough.

Ultimately, the conversation challenges the traditional medical view of adrenal insufficiency and calls for a shift in how it is recognized and treated. Patients should not have to collapse before they are believed.

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