Adrenaline symptoms: causes and warning signs of imbalance

Introduction

Adrenaline symptoms are something people often search for when the body feels like it is “running at full throttle”: the heart is pounding, the hands are shaking, sleep is broken, or anxiety hits suddenly in a wave. Adrenaline, also known as epinephrine, is a normal stress hormone, but the pattern of symptoms depends on whether you are dealing with an ordinary stress response, medication or a rarer endocrine cause.

How do adrenaline symptoms develop in the body?

Adrenaline is produced by the adrenal medulla and belongs to the catecholamines, along with noradrenaline and dopamine. An NIH NCBI overview of the adrenal gland describes how catecholamines prepare the body for fast action: heart rate and cardiac output increase, blood pressure may rise, the bronchi widen, and the mobilization of glucose and fats gives the muscles quickly usable energy (https://www.ncbi.nlm.nih.gov/books/NBK26/).

In practice, this means adrenaline symptoms can include palpitations, tremor, sweating, pallor, dry mouth, tightness in the chest, nausea, cold hands, restlessness, difficulty concentrating and a feeling that something is about to happen. These symptoms do not in themselves prove excess hormone production. The same physical picture can come from anxiety, caffeine, nicotine, sleep deprivation, fever, pain, blood sugar fluctuations, certain medications or too sudden a rise in training load.

The stress response is not only “mental”. A meta-analysis by Goldstein and Kopin showed that different stressors activate the adrenomedullary, adrenocortical and sympathetic systems to different degrees; adrenaline, noradrenaline and ACTH do not always move in the same rhythm (Goldstein and Kopin, 2008). That is why a person can feel strong palpitations even when blood tests do not point to persistent hormonal overactivity.

What causes the feeling of high adrenaline?

The most common triggers are physical or psychological stress, poor sleep, a heavy workload, conflict, pain, fever, hypoglycemia (low blood sugar), the period after drinking alcohol, nicotine, too much caffeine and some medications. Training can also raise adrenaline and noradrenaline, which is a normal part of adapting to training load. It becomes a problem when training load, recovery and sleep are out of balance.

In a fitness context, it is important to tell normal training arousal from warning symptoms. Competition prep, calorie restriction, poor sleep and heavy stimulation can create a feeling that the body is in a constant state of alert. People who work purposefully toward stage condition can experience similar tension; this connects well with The journey from dreams to the stage – part 7 is out, where, with a long-term goal, managing recovery becomes just as important as the training itself.

Adrenaline does not explain every uncomfortable bodily sensation, though. For example, muscle twitches and cramps can be linked to training load, fluid balance, electrolytes, fatigue or nervous system irritability. If your main concern is cramping rather than palpitations or episodic sweating, it is worth also reading Muscle cramps.

When can adrenaline symptoms point to illness?

Rarely, the cause behind the symptoms can be a pheochromocytoma or paraganglioma, a tumor that produces catecholamines. According to a review by Pappachan and colleagues, most of these tumors originate from the adrenal medulla, and excess catecholamines can cause persistent or episodic high blood pressure together with sweating, headache and palpitations (Pappachan et al., 2018). The same review stresses that diagnosis relies on plasma free metanephrines or fractionated metanephrines in urine collected over a full day, not on a description of symptoms alone (Pappachan et al., 2018).

Manger’s review describes the typical manifestations of pheochromocytoma as episodic high blood pressure, headache, palpitations or tachycardia, inappropriate sweating, anxiety, tremor, pallor, chest or abdominal pain, nausea and vomiting (Manger, 2009). Importantly, this disease can mimic a panic attack, migraine, heart disease or a gastrointestinal complaint. For that reason, you should not label repeated severe episodes as “stress” on your own, especially if they come with a sudden rise in blood pressure.

Medical assessment is needed quickly if the symptoms come with chest pain, shortness of breath, fainting, a neurological symptom, a very severe headache, repeated vomiting or very high blood pressure. A routine consultation with a family doctor or an endocrinologist makes sense if the episodes recur, occur at night, start without a clear trigger or interfere with training, sleep and work.

How can you tell stress, panic and a hormonal cause apart?

A good first step is a symptom diary: when the episode began, how long it lasted, what came before it, and whether there was caffeine, alcohol, medication, intense training, fasting, poor sleep or emotional tension. It is worth noting your pulse and blood pressure, if they can be measured calmly and correctly. A single number is not a diagnosis, but the pattern helps the doctor decide whether heart, thyroid gland, blood sugar, medication or adrenal tests are needed.

An Endocrine Society patient resource explains that the adrenal glands produce several hormones, including cortisol, aldosterone and adrenaline, and that these affect blood pressure, metabolism and the stress response (https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/adrenal-hormones). That is why “hormones out of balance” is not a sufficient diagnosis: a doctor has to establish which system is disturbed and whether the symptoms come from the adrenal gland at all.

With age, sleep disturbances, loss of muscle mass, changes in blood pressure and slower recovery can also make the stress response more noticeable. If symptoms are long-lasting and intertwined with a general change in how you feel, II Symptoms of aging can serve as background reading, but even then the principle stays the same: a diagnosis is not made on how you feel alone.

What can you do yourself, and what should you avoid?

If there are no dangerous symptoms, the practical approach starts with getting recovery in order: regular sleep, moderate training, cutting back on caffeine and nicotine, eating enough, a break from alcohol, and gradual planning of training load. With pre-workout stimulants and fat burners, it is worth checking the ingredients, because caffeine and other stimulants can amplify the feeling of an adrenaline rush.

What not to do: order random “adrenaline tests”, start hormone medications, interpret a single lab result without a doctor, or mask recurrent attacks with sedatives, alcohol or a new stimulant. If adrenaline symptoms are frequent, severe or come with surges in blood pressure, the evidence-based route is a medical evaluation and, if needed, targeted biochemical testing.

References

• Goldstein DS, Kopin IJ (2008). Adrenomedullary, adrenocortical, and sympathoneural responses to stressors: a meta-analysis. Endocrine Regulations. PMID: 18999898; PMCID: PMC5522726.
• Manger WM (2009). The protean manifestations of pheochromocytoma. Hormone and Metabolic Research. PMID: 19242899; DOI: 10.1055/s-0028-1128139.
• Pappachan JM, Tun NN, Arunagirinathan G, Sodi R, Hanna FWF (2018). Pheochromocytomas and Hypertension. Current Hypertension Reports. PMID: 29356966; DOI: 10.1007/s11906-018-0804-z.
• Kvetnansky R, Sabban EL, Palkovits M (2009). Catecholaminergic systems in stress: structural and molecular genetic approaches. Physiological Reviews. PMID: 19481082; DOI: 10.1152/physrev.00042.2006.

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