Tired of Being Tired?

An Update on Adrenal Dysfunction and CAR


Are You Tired of Being Tired?

Cortisol is the body's main stress hormone and is released in a natural diurnal circadian pattern under ideal circumstances. However, as we face many different daily stressors additional cortisol release is provoked. Repeated activation of this "fight or flight" response can lead to HPA axis disruption and dysregulation.

In addition to cortisol's circadian rhythm, there is a separate and distinct transient increase in cortisol triggered merely by the act of waking in the morning. This is called the "Cortisol Awakening Response" or CAR. This response offers additional insight into the resiliency of the HPA axis and has distinct health implications. Assessing cortisol using both CAR and the diurnal rhythm helps to identify abnormalities and allows clinicians to address root causes.


  • Review of the HPA axis
  • Define what CAR is and how it is related to HPA axis
  • Use case review to discuss what to do with an altered CAR

Filomena Trindade, MD MPHFilomena Trindade, MD MPH

Filomena Trindade, MD, MPH is an international sought after speaker in functional medicine. She is a graduate of the fellowship in Anti-Aging, Regenerative and Functional Medicine and teaches in the Fellowship (a master's program through the University of South Florida) as well as for the Institute of Functional Medicine (IFM).

After obtaining her BA degree in Biology she went on to finish a master's in Public Health in the area of environmental health and epidemiology before starting medical school. She graduated first in her class in family practice from the University of California Davis School of Medicine and did her residency training in family practice at the U.C. San Francisco/Santa Rosa Program. She has been in clinical practice for over 16 years.

Before starting her own private practice in 2004 in functional medicine she was the medical director of a non-profit organization that catered to the under-served. She is currently very active in developing teaching programs in Functional Medicine in the USA, Latin America and Europe.

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