The Invisible Earthquake - Understanding Adrenal Insufficiency

What if the shaking you feel isn’t anxiety at all — but your body trying to survive?

In this episode, Chloe and Alex explore one of the most frightening and misunderstood symptoms many people with adrenal insufficiency experience: the internal trembling often described as an “earthquake from within.”

To someone watching from the outside, nothing may look wrong. A person might simply appear pale or tired. But inside, the experience can feel intense — buzzing, vibrating, heart pounding, and a sense that the floor is dropping out beneath you. Because these symptoms resemble panic attacks, many patients are told the problem is anxiety.

This episode explains why that interpretation is often incorrect.

Drawing from the My Adrenal Life deep dive “The Earthquake From Within,” Chloe and Alex break down the physiology behind this sensation and why it happens when cortisol levels are too low.

The conversation begins with a simple but critical fact about the adrenal glands: they have two different parts.

• The adrenal cortex produces cortisol and aldosterone.

• The adrenal medulla produces adrenaline (epinephrine).

In adrenal insufficiency, the cortex cannot produce adequate cortisol. But the adrenaline system usually still works — and without cortisol to regulate it, the body may rely on adrenaline much more heavily to maintain blood pressure, blood sugar, and circulation.

The result can be powerful adrenaline surges that feel almost identical to anxiety, even when the person’s mind is calm.

Chloe and Alex explore several physiologic triggers that can lead to these internal “earthquakes,” including:

• drops or rapid shifts in blood sugar

• low blood pressure or poor vascular tone

• dehydration or sodium imbalance (especially in primary adrenal insufficiency)

• standing up quickly or postural changes

• heat exposure

• illness or pain

• emotional stress

• long gaps between medication doses

They also explain the important role cortisol normally plays in stabilizing blood sugar through a process called gluconeogenesis, which helps ensure the brain has a steady supply of glucose. When cortisol is insufficient, the body may rely on adrenaline to mobilize energy quickly — and that adrenaline surge is what produces the shaking, buzzing, and pounding sensations many patients describe.

The episode also explores why these symptoms are frequently misinterpreted in medical settings. Shaking, rapid heart rate, and feelings of impending danger are classic signs of panic attacks. Without awareness of adrenal insufficiency, clinicians may assume the cause is psychological rather than endocrine.

Chloe and Alex discuss why language can matter when describing these episodes. Explaining that the body may be releasing adrenaline because cortisol levels are insufficient can help shift the conversation toward the underlying physiology rather than emotional interpretation.

They also touch on tools that some patients find helpful in understanding their patterns, including wearable devices that track heart rate, heart rate variability (HRV), and physiologic stress signals. For some individuals, these patterns can provide additional context when discussing symptoms with healthcare providers.

Finally, the episode discusses the importance of recognizing these sensations as early warning signals. The internal “earthquake” is often the body’s way of saying that current cortisol coverage may not be matching physiologic demand.

Understanding these signals can help people respond earlier with appropriate rest, hydration, nutrition, or medical guidance from their healthcare team.

At its core, this episode is about validation. Many people with adrenal insufficiency have experienced this invisible trembling and wondered if they were imagining it.

They are not.

Sometimes what feels like anxiety is actually biochemistry trying to keep the body alive.

Visit us at www.MyAdrenalLife.com and our Facebook Group to learn more and connect with others living with adrenal insufficiency.