Hormones influence nearly every system in the body, from regulating brain chemistry, immune balance, metabolism, digestion, to how we respond to stress.
For children with PANS/PANDAS, these system are already under pressure. Then, when you add HPA axis dysfunction, cortisol imbalances, and blood sugar instability into the mix, and things can quickly escalate.
From our experience with practitioners, other parents’ stories, to the research, hormones are often overlooked in PANS/PANDAS treatment. But working on hormonal regulation, a healthy stress response, and metabolic flexibility can help move the needle.
The HPA Axis | The Body’s Stress Manager
The hypothalamic-pituitary-adrenal (HPA) axis is the body’s stress management system. It’s a communication network between three glands:
- Hypothalamus (located in the brain) – The master regulator that detects stress and signals the pituitary gland
- Pituitary Gland– Receives signals from the hypothalamus and tells the adrenal glands to release cortisol.
- Adrenal Gland– Responds by producing cortisol and adrenaline.
It controls the release of cortisol, the primary stress hormone, which helps regulate:
- Energy levels
- Sleep-wake cycles
- Inflammation
- Blood sugar
- Mood and focus
When functioning properly, the HPA axis keeps everything in balance, cortisol rises in the morning to help us wake up, falls throughout the day, and reaches its lowest point at night for restful sleep.
Adrenaline & Cortisol? Our Internal Stress Response Process
Cortisol is known as the “stress hormone,” but adrenaline (epinephrine) also plays a role in how the body responds to stress. Cortisol works slowly and lasts longer, but adrenaline kicks in right away when the body senses danger.
This is how our body responds to a stressor:
↪️ The hypothalamus detects a stressor (physical, emotional, immune-related) and releases corticotropin-releasing hormone (CRH).
↪️ CRH signals the pituitary gland to release adrenocorticotropic hormone (ACTH).
↪️ ACTH goes to the adrenal glands. It stimulates the release of adrenaline (epinephrine) for a quick response.
↪️ In response, heart rate increases and blood pressure rises to increase oxygen delivery. Blood sugar spikes to provide quick energy. The brain enters a hyper-focus mode to prioritize survival. If the stress continues, the adrenal glands release cortisol which provides longer-term support by:
- Keeping blood sugar elevated and suppressing non-essential functions (like digestion, reproduction and immune response) to prioritize survival.
- Regulating inflammation, which can become problematic when cortisol is either too high or too low.
Once the stressor is gone, the HPA axis “turns off”, allowing cortisol levels to return to normal and shift back into rest-and-digest mode.
But in PANS/PANDAS, chronic infections, immune dysfunction, and neuroinflammation can throw the HPA axis into dysregulation, leading to:
- Hyperactive HPA Axis (Stuck in “Fight or Flight”)
- Burned-Out HPA Axis (“Adrenal Fatigue”)
Hyperactive HPA Axis | Stuck in Fight or Flight
When the HPA axis is constantly being triggered, cortisol remains elevated, which keeps the body on high alert indefinitely. When the body senses an ongoing threat like a chronic infection, toxins, or emotional stress, cortisol stays elevated and the body never receives the all clear. Add in excess adrenaline and you get sudden mood swings, sensory issues and aggression.
Symptoms of High Cortisol & High Adrenaline:
- Chronic anxiety, panic attacks, OCD – Excess cortisol overstimulates the amygdala, the brain’s fear center, leading to heightened anxiety and obsessive-compulsive behaviors.
- Sleep disturbances – Many experience middle-of-the-night wake-ups (often around 3 AM) due to cortisol spikes interfering with melatonin production.
- Increased heart rate and high blood pressure – Cortisol keeps the sympathetic nervous system (“fight-or-flight”) activated, leading to heart palpitations, dizziness, and blood pressure fluctuations.
- Suppressed immunity – High cortisol lowers immune defenses, making individuals more susceptible to infections, viruses, and chronic inflammation. (Source)
- Aggressive outbursts & rage –Adrenaline surges can trigger sudden, intense emotional reactions that seem disproportionate to the situation.
- Sugar cravings and energy crashes – High cortisol and adrenaline spike blood sugar, leading to energy crashes and metabolic instability that worsen mood and focus.
- Digestive issues – When the body prioritizes survival, it diverts energy away from digestion, causing bloating, constipation, and gut dysbiosis.
What Causes High Cortisol?
- Chronic infections (Lyme, mold toxicity, viral reactivations, PANS/PANDAS)
- Psychological and emotional stress (trauma, anxiety, PTSD, caregiving stress)
- Blood sugar instability (high-carb diets, skipping meals, reactive hypoglycemia)
- Environmental toxins (pesticides, heavy metals, plastics, endocrine disruptors)
Hypoactive Burned Out HPA Axis | Adrenal Fatigue
After prolonged periods of chronic stress or illness, the adrenal glands become exhausted, resulting in the body not putting out enough cortisol. The body, no longer able to sustain high cortisol production, enters a state of HPA axis burnout, leading to extreme fatigue, brain fog, and an increased risk of autoimmune flares. In this state, the body may relay more on adrenaline surges, resulting in bursts of wired energy followed by crashes.
Symptoms of Low Cortisol:
- Chronic fatigue and low energy –Exhausted upon waking, even after a full night’s sleep, and afternoon energy crashes.
- Brain fog, poor focus, memory issues – Low cortisol affects cognitive function, making it harder to concentrate, recall information, or stay mentally sharp. (Source)
- Low blood pressure and dizziness – Without enough cortisol, the body struggles to regulate blood pressure, leading to lightheadedness when standing.
- Mood instability (depression, irritability) – Cortisol helps regulate neurotransmitters like serotonin and dopamine. Low levels contribute to depression, irritability, and low motivation.
- Increased inflammation, pain, and autoimmune flares – Cortisol is naturally anti-inflammatory. When it’s too low, chronic inflammation worsens, triggering joint pain, muscle aches, and immune system overactivity.
What causes Low Cortisol?
- Prolonged chronic stress (physical, emotional, or immune-related)
- Chronic infections or toxin exposure (Lyme, mold, heavy metals, viral reactivations)
- Overuse of stimulants (caffeine, sugar, excessive exercise pushing the adrenals further into depletion)
- Blood sugar crashes & hypoglycemia (when blood sugar drops, the adrenals must compensate with cortisol release, but in burnout, they can’t keep up—leading to worsening fatigue and poor metabolic resilience.
Blood Sugar & The HPA Axis | Keeping Kids on an Even Keel
The HPA axis and blood sugar regulation are deeply interconnected with blood sugar regulation, working closely with the pancreas and liver to maintain stability. When the body perceives stress, whether from emotional distress, infections, toxins, or unstable blood sugar, the HPA axis signals the release of cortisol. When the HPA axis triggers cortisol release, the liver dumps stored glucose into the bloodstream to provide energy for a fight-or-flight response.
In a healthy system, insulin brings blood sugar back into balance by moving glucose into cells. But when stress is chronic, cortisol stays elevated, leading to constant glucose release, overworked insulin production, and eventual insulin resistance. This pushes kids into a cycle of crashes, irritability, and poor energy regulation.
Balanced blood sugar isn’t just about energy levels, it’s foundational for metabolic flexibility, nervous system stability, and emotional regulation. Many kids with PANS/PANDAS lack this flexibility; their bodies depend heavily on glucose for quick fuel and struggle to adapt when levels drop. This can make skipping a meal or eating a sugary snack a major trigger for behavioral regression.
To prevent these spikes and crashes, a diet focused on whole foods with a low glycemic index, which break down slowly in the body, is key.
Adding protein and healthy fats to meals also helps. These nutrients slow down sugar absorption, providing a steady energy release and keeping kids feeling full and focused longer. Breakfasts like eggs and avocado toast or snacks like nuts and apples can help stabilize blood sugar, reduce mood swings, and support better focus.
Blood Sugar as a Metabolic Trigger
In a child with PANS/PANDAS, even minor blood sugar drops can act as a metabolic “stress signal,” activating the HPA axis and triggering a cortisol surge. This rapid response may lead to adrenaline spikes, mood swings, and increased neuroinflammation, especially in kids who are already dealing with chronic infections or toxin overload.
Over time, repeated episodes of glucose instability wear down the body’s ability to maintain balance. This is where metabolic dysfunction and blood sugar regulation overlap: if the body can’t stabilize its fuel source, the brain and immune system become more reactive, and flares become harder to control.
Symptoms of Blood Sugar Dysregulation
- Mood swings, irritability, and panic attacks – Blood sugar fluctuations can cause adrenaline spikes, leading to increased anxiety, irritability, and emotional instability.
- Brain fog, dizziness, and sugar cravings – Low blood sugar deprives the brain of the steady glucose it needs to function properly. This results in poor concentration, dizziness, and a need for quick sugar fixes.
- Waking up at 3 AM – Nighttime blood sugar crashes trigger cortisol spikes, causing sudden wake-ups in the early morning hours.
- Energy crashes after meals – A spike in blood sugar, often from consuming refined carbs, is quickly followed by an insulin surge that causes an energy slump and increased hunger.
Balancing Blood Sugar & Cortisol
- Protein + Healthy Fats at Every Meal – Helps maintain steady blood sugar and prevents sharp spikes and crashes.
- Avoid Refined Sugars & Processed Carbs – Minimizes insulin surges that lead to energy dips and cravings.
- Magnesium + B Vitamins – Essential for adrenal function, cortisol regulation, and blood sugar stability.
- Eat Every 3-4 Hours – Prevents hypoglycemia-induced stress responses and supports consistent metabolic energy.
HPA Axis Dysfunction & Chronic Inflammation
HPA axis dysfunction does more than just disrupt hormones. It drives chronic inflammation, something these kids need less of, not more.
While cortisol is an anti-inflammatory hormone in short bursts, chronic stress causes it to become either too high (leading to immune suppression) or too low (failing to regulate inflammation properly). This imbalance can fuel widespread inflammation, leading to other downstream effects:
- Autoimmunity– Chronic HPA axis activation has been linked to autoimmune diseases like Hashimoto’s. Prolonged stress triggers immune dysregulation, increasing the likelihood of the body attacking its own tissues.
- Neuroinflammation – The brain is highly sensitive to HPA axis dysfunction. Chronic stress fuels inflammation in the brain, making the blood-brain barrier more permeable and allowing toxins and immune cells to attack brain tissue. This can worsen symptoms like mood swings, cognitive dysfunction, and neuropsychiatric behavior.
- Gut Disorders – Chronic cortisol elevation can cause gut permeability, allowing harmful particles to leak into the bloodstream, triggering systemic inflammation. This can also disrupt the balance of gut microbiota, leading to dysbiosis.
Environmental Toxins & Hormones
Endocrine-disrupting chemicals (EDCs) are synthetic chemicals and environmental toxins that interfere with the body’s hormonal balance, mimicking or blocking natural hormones, including cortisol, which can contribute to HPA axis dysfunction.
Sources of EDCs & Hormone Disrupting Toxins
- Plastics (BPA, BPS, & Phthalates) – Found in plastic bottles, food containers, and canned goods.
- Pesticides & Herbicides (Glyphosate, Atrazine) – Used in conventional farming.
- PFAS (“Forever Chemicals”) – Found in non-stick cookware, waterproof fabrics.
- Heavy Metals (Mercury, Lead, Cadmium, Aluminum) – Found in polluted water, industrial waste, and some cosmetics.
EMFs Impact on Melatonin & Cortisol Cycles
In today’s digital world, constant exposure to screens, WiFi, and electromagnetic fields (EMFs) has become an unavoidable part of life. While technology brings convenience, it also introduces invisible stressors that can significantly disrupt hormonal balance, particularly the sleep-wake cycle regulated by melatonin and cortisol.
How EMFs Disrupt Melatonin Production
Melatonin is the body’s primary sleep hormone, responsible for signaling the brain when it’s time to rest. It follows a circadian rhythm, naturally rising in the evening as darkness sets in and peaking around bedtime to promote deep, restorative sleep. However, EMF exposure has been shown to suppress melatonin levels, making it harder to fall and stay asleep. (Study)
Artificial Light & Blue Light Exposure: Screens (phones, tablets, TVs) emit blue light, which tricks the brain into thinking it’s still daytime. This suppresses melatonin production, delaying sleep onset and reducing overall sleep quality.
Cell Phones & WiFi Radiation: Studies suggest that radiofrequency (RF) radiation from wireless devices can reduce the pineal gland’s ability to produce melatonin, leading to lighter, disrupted sleep cycles and an increased risk of insomnia. (Study)
How EMFs Keep the HPA Axis in a State of Stress
The HPA axis is highly sensitive to environmental stressors, including EMF exposure. The body perceives EMFs as a low-level stress signal, causing the adrenal glands to release cortisol.
Cortisol Dysregulation: Normally, cortisol peaks in the morning to help us wake up and gradually decreases throughout the day. However, prolonged EMF exposure has been linked to nighttime cortisol spikes, making it harder for the body to transition into a relaxed, parasympathetic state needed for sleep.
Increased Inflammation & Oxidative Stress: EMFs have been shown to trigger cellular stress responses, leading to inflammation, mitochondrial dysfunction, and oxidative stress, all of which further disrupt hormone balance and increase overall biological stress.
Tips to Reduce EMF Exposure & Improve Hormonal Balance
- Turn Off WiFi at Night: Cutting down on wireless signals while sleeping allows the nervous system to reset and helps lower cortisol levels overnight.
- Use Blue Light Filters or Night Mode: Devices now offer settings that reduce blue light exposure, minimizing melatonin suppression in the evening.
- Keep Phones & Devices Out of the Bedroom: Charging a phone on the nightstand or sleeping next to WiFi-connected devices exposes the brain to EMFs all night, interfering with deep sleep cycles.
- Opt for Wired Internet Instead of WiFi (When Possible): Using ethernet cables instead of wireless internet reduces RF radiation exposure in the home.
- Grounding & Natural Light Exposure: Spending time outdoors in natural sunlight during the day helps reset the body’s circadian rhythm, making it easier to produce melatonin at night.
By reducing EMF exposure, especially in the evening, we allow the body’s natural cortisol and melatonin cycles to function properly, leading to better sleep, improved stress resilience, and more balanced hormone regulation.
How to Heal the HPA Axis & Restore Balance
Reduce Stress Exposure
- Limit Screen time & EMF exposure (WiFi & bluelight disrupt melatonin & cortisol)
- Reduce environmental toxins (EDCs, switch to glass containers, use air purifiers and non-toxic personal care products)
- Establish healthy boundaries (emotional & social stress directly impact HPA function)
Support the Nervous System
- Morning Sunlight Exposure – Resets the circadian rhythm & cortisol cycle
- Deep Breathing & Vagus Nerve Activation – Stimulates the parasympathetic nervous system
- Gentle Movement (Yoga, Walking, Rebounding) – Lowers cortisol without overtaxing the system
Balance Blood Sugar & Nutrient Deficiencies
- Eat Balanced Meals (Protein + Fats + Fiber)
- Magnesium, Zinc, & B-Vitamins – Support adrenal repair and blood sugar metabolism
- Electrolytes – Help regulate low blood pressure & adrenal fatigue
Adaptogenic Herbs & Supplements
- Ashwagandha & Rhodiola – Help modulate cortisol
- Phosphatidylserine – Lowers high cortisol at night
- Licorice Root – Helps increase low cortisol (use with caution)
Parental Burnout | Your Hormones Matter Too
Managing PANS/PANDAS is an intense and often exhausting journey, not just for the child, but for the entire family. At the very least, caring for a child with PANS/PANDAS is incredibly stressful—at worst, it’s traumatic, and that unrelenting stress takes a toll on your body in ways we often overlook or downplay. I know I was stuck with 3am nightly wake-ups until I realized this was cortisol and took steps to correct it.
Understanding how hormones, the HPA axis, and blood sugar regulation play into your child’s condition is key to helping them heal. But it’s equally important for you, as a parent, to consider these factors for your own health.
We cannot pour from an empty cup.
HPA axis dysfunction is a foundational imbalance that impacts every system in the body. Addressing HPA dysfunction can reduce inflammation, stabilize mood, improve immune function, and restore metabolic balance. All things we ALL need!