Adrenal Fatigue - Truth or Myth

By Ricardo Correa, MD, Vishnu Garla, MD, Sina Jasim, MD, Michael Irwig, MD, and Irina Bancos, MD
tired woman

The adrenal glands are small glands that sit on top of the kidneys and secrete steroid hormones such as cortisol. Adrenal insufficiency is a disorder characterized by low production of cortisol. Patients with untreated adrenal insufficiency complain of fatigue, weight loss, abdominal discomfort, dizziness, and other symptoms. Adrenal insufficiency may not be initially recognized as the symptoms are vague and may overlap with many other disorders.

"Adrenal fatigue" is an unrecognized condition said to be due to the relative deficiency of cortisol in response to chronic stress. A Google search for the term "adrenal fatigue" yielded close to 25 million results, indicating the widespread use of this term. This term has been used in various popular health books (including “Adrenal Fatigue for Dummies”), alternative medicine websites and patient forums. Variable supplements including micronutrients (magnesium, vitamin C) and herbs (basil, aswagandha, and licorice) and “adrenal” supplements (frequently made from animal adrenal, pituitary, and gonadal glands) are available online for purchase and claim to cure adrenal fatigue. These supplements are expensive, have no proven benefits, and some have been shown to cause harm.

Adrenal Insufficiency versus “Adrenal Fatigue”

Adrenal insufficiency Adrenal fatigue
Deficiency of cortisol and other adrenal hormones. Etiology is autoimmune, post-surgery, infiltrative disorders, pituitary mass. Believed to be due to the inability of the adrenal gland to meet the increasing demand for cortisol induced by stress.
Clinical features include fatigue, weight loss, dizziness, and abdominal discomfort. May have fatigue, difficulty sleeping or waking up, crave salt and need caffeine to get through the day.

A variety of unsubstantiated methods to diagnose adrenal fatigue have been put forward, predominantly consisting of questionnaires and unvalidated hormone assessments. Commonly used hormonal assessments to diagnose adrenal fatigue consist of testing salivary cortisol at different times of the day (cortisol awakening response, direct awakening cortisol, etc.). These tests have shown inconsistent results in patients with the same symptoms.

If it’s not adrenal fatigue, then what is it?

"Multiple disorders may present with similar symptoms, which can be misconstrued as adrenal fatigue."

Although adrenal fatigue is not an actual disorder, patients’ symptoms and concerns can be debilitating and need proper evaluation and management. Multiple disorders may present with similar symptoms, which can be misconstrued as adrenal fatigue. The initial evaluation should include a careful history of the symptoms’ origin, progression, history of concurrent chronic disorders and medications. Close attention should be taken to evaluate for psychiatric conditions which may present as fatigue. The most common conditions that can potentially be labelled as adrenal fatigue are:

Adrenal insufficiency: The adrenal glands are not capable of producing cortisol. It may be secondary to either adrenal or pituitary problems. It is characterized by fever, weight loss, abdominal pain, and dizziness and other symptoms.

Chronic fatigue syndrome is characterized by debilitating fatigue along with physical symptoms (at least four of the following: muscle pain, multi-joint pain, sore throat, tender lymph nodes, short term memory loss, headaches, or unrefreshing sleep). It is diagnosed only after ruling out other causes of fatigue.

Obstructive sleep apnea is a sleep-related breathing disorder characterized by complete or incomplete cessation of breath-ing, unrefreshed sleep, excessive daytime sleepiness, and fatigue. Diagnosis is made by performing a sleep study. Treatment involves lifestyle changes for weight loss and continuous positive airway pressure.

Fibromyalgia: Fibromyalgia is often accompanied by fatigue, memory problems, and sleep disturbances. The treatment includes non-pharmacological methods like cognitive behav-ioral therapy, exercise and pharmacological therapy with some drugs that have been approved by the Food and Drug Administration (FDA).

Depression: Depression can manifest as fatigue, loss of appetite, loss of interest and insomnia. The diagnosis can be made with a thorough clinical history and exam. Treatment includes use of behavioral therapy and antidepressants.

In conclusion, not every fatigue is adrenal in origin. It is crucial that if you have some symptoms suggestive of adrenal insufficiency to visit a board-certified endocrinologist so he/she can evaluate you and determine what is the correct diagnosis and treatment if needed.