Case Study:

Patient: Sarah, 35-year-old accountant

Presenting symptoms: Fatigue, weight gain, anxiety, difficulty concentrating, frequent headaches, insomnia

Medical history: No significant medical history, occasional use of over-the-counter pain relievers

Clinical findings: Elevated blood pressure, slight central obesity, increased fasting blood sugar, elevated cortisol levels, low IGF-1 levels

Diagnosis: Suspected chronic stress with hormonal imbalances impacting energy metabolism, mood, and cognitive function.


Sarah’s symptoms and clinical findings suggest a dysregulation in the cortisol-IGF-1 axis. Her elevated cortisol levels indicate prolonged stress activation, likely due to her demanding work environment and financial concerns. This chronic stress has led to:

  • Metabolic dysregulation: Cortisol’s catabolic effects contribute to weight gain and impaired glucose metabolism, contributing to her elevated blood sugar and potential risk of prediabetes.
  • Reduced resilience: Chronically high cortisol suppresses IGF-1, leading to fatigue, difficulty concentrating, and weakened immune function, explaining her fatigue, anxiety, and frequent headaches.
  • Sleep disturbances: Cortisol’s interference with sleep cycles contributes to her insomnia, further exacerbating fatigue and stress.

Treatment plan:

  1. Stress management:

    • Cognitive-behavioral therapy (CBT) to identify and reframe negative thought patterns.
    • Mindfulness and relaxation techniques like meditation and yoga to regulate cortisol levels.
    • Regular exercise to promote stress relief and boost IGF-1 production.
  2. Dietary adjustments:

    • Balanced diet rich in fruits, vegetables, whole grains, and lean protein to provide essential nutrients and stabilize blood sugar.
    • Limit processed foods, sugary drinks, and excessive caffeine to minimize cortisol spikes.
    • Prioritize regular meals and avoid skipping breakfast to prevent cortisol surges due to low blood sugar.
  3. Sleep hygiene:

    • Establish a regular sleep schedule and stick to it, even on weekends.
    • Create a relaxing bedtime routine to promote sleep onset.
    • Optimize the sleep environment with darkness, quiet, and cool temperature.
  4. Supportive care:

    • Individual therapy to address underlying emotional stressors and build coping mechanisms.
    • Building strong social connections and support networks to buffer against stress.


With commitment to the treatment plan, Sarah can expect to see a gradual improvement in her symptoms. By managing her stress and optimizing her lifestyle, she can restore balance to her cortisol-IGF-1 axis, leading to:

  • Improved energy levels and weight management
  • Reduced anxiety and enhanced mood
  • Greater cognitive clarity and focus
  • Better sleep quality and overall well-being

Long-term management:

Ongoing monitoring of cortisol and IGF-1 levels alongside periodic evaluations by a healthcare professional will be crucial to maintain hormonal balance and prevent future relapses. Sarah can continue practicing stress management techniques, maintaining a healthy lifestyle, and prioritizing self-care to live a life filled with resilience and well-being.

Dopamine and Adrenal Disorders: Hormonal Implications and Management

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