An Overview of Adrenal Fatigue

Understanding the controversy and what you should know about symptoms

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Table of Contents

The term adrenal fatigue was coined to describe symptoms of fatigue, insomnia, salt and sugar cravings, and more that occur when a person is exposed to chronic stress. The theory is that such stress impacts the adrenals (glands that make stress hormones) so that they "burn out" and fail to produce a sufficient amount of hormones such as cortisol. While most experts do not accept that adrenal fatigue is a "real" disease, these symptoms are very real to those who experience them.

Adrenal fatigue can almost seem like a welcome label for frustrating symptoms some have long sought to find a reason for, but accepting it as an answer without further investigation may result in missing a diagnosis that can have similar characteristics, such as sleep apnea, an autoimmune condition, or primary adrenal insufficiency (a recognized condition that can be life-threatening if not caught).

symptoms of adrenal fatigue
Illustration by Emily Roberts, Verywell

The Theory

The concept of adrenal fatigue was coined in 1998 by a chiropractor and naturopath. It relates to the response of the adrenal glands to prolonged stress and has been the subject of significant debate.

The adrenal glands are two small glands that are located on top of both kidneys. These glands are made up of two parts, each of which secretes different types of hormones in response to physical or emotional stress:

  • Adrenal cortex: The outer part of the adrenal gland, it secretes steroid hormones that regulate functions such as metabolism and the immune system. It is made up of three zones, or "zonas," which include the glomerulosa, fasciculata, and reticularis. Hormones secreted include glucocorticoids (hormones, such as cortisol, that help the body respond to stress) and mineralocorticoids. The primary mineralocorticoid, aldosterone, plays an important role in regulating the balance of sodium and potassium in the body, which in turn helps to regulate blood pressure. These hormones are part of a complex feedback loop that involves stimulation of the adrenal gland by the pituitary hormone ACTH (adrenocorticotropic hormone).
  • Adrenal medulla: This region produces epinephrine (adrenaline) and norepinephrine. These "fight-or-flight" hormones are released in response to stress.
Cross-section of an adrenal gland.

The theory is that chronic stress or severe acute stress wears down the adrenal glands so that they produce fewer stress hormones when stressors continue.

While primary adrenal insufficiency is a known medical condition associated with low levels of these hormones, the theory claims that adrenal fatigue is a milder form of the condition that just can't be diagnosed based on conventional lab tests.

According to the theory, some people are more likely to develop adrenal fatigue than others, including single parents, shift workers, people who are unhappily married, those who have stressful jobs, people who have chemical dependency issues, and people who work all the time to the exclusion of play.

Controversy

The concept of adrenal fatigue is very controversial, and it is not considered an official medical condition by most professional medical organizations, including the Endocrine Society. While stress does affect the adrenal glands, experts who don't support the theory point out that more cortisol usually results—not less.

In fact, a 2016 review of 58 studies concluded by saying: "This systematic review proves that there is no substantiation that 'adrenal fatigue' is an actual medical condition. Therefore, adrenal fatigue is still a myth."

Symptoms

Proponents of the concept of adrenal fatigue claim that it is characterized by several non-specific symptoms such as:

  • Extreme fatigue, with many people needing stimulants such as caffeine for normal daily activities
  • Sleep problems, such as insomnia
  • Feeling overwhelmed by or unable to cope with stress
  • Cravings for salty and sweet foods
  • Difficulty concentrating or brain fog
  • Poor digestion
  • Weight gain (especially abdominal)
  • Muscle and joint pain

Cause

Those who support a diagnosis of adrenal fatigue claim that it often occurs in response to chronic stress, but that it may also occur with acute stress such as respiratory infections.

Diagnosis

Adrenal fatigue not being officially recognized leaves the reality that people have very real symptoms that are leading to suffering. Those with these symptoms deserve compassion, a thorough workup looking for recognized (but often overlooked) medical causes, and a thoughtful treatment plan.

Proponents of the adrenal fatigue theory claim that conventional blood tests are not sensitive enough to detect the abnormalities found with adrenal fatigue—in essence, saying that the condition exists, but cannot be proven by labs. Some practitioners recommend saliva tests, though these tests are not accepted as reliable by most of the medical community.

Confirming or ruling out primary adrenal insufficiency is the path most doctors instead take. The ACTH stimulation test can detect if the adrenal glands can be stimulated by ACTH to make cortisol. If they can, they are still functioning normally.

Primary Adrenal Insufficiency vs. Adrenal Fatigue

Primary adrenal insufficiency, also referred to as Addison's disease or hypocortisolism, is a rare autoimmune condition characterized by low levels of adrenal hormones (primarily cortisol, but sometimes aldosterone as well). This occurs when the adrenal glands fail to produce adequate hormones despite normal or increased production of ACTH by the pituitary gland.

Sometimes associated with autoimmune thyroid disease, Addison's disease is characterized by symptoms of fatigue, weight loss, nausea and vomiting, skin discoloration, and more, with the potential of life-threatening episodes (referred to as an adrenal crisis) occurring in response to major stress.

Primary adrenal insufficiency is confirmed with a combination of diagnostic tests (such as an ACTH stimulation test) and imaging tests (such as computed tomography, or a CAT scan) of the adrenal glands.

In contrast, when the term adrenal fatigue is used, it refers to a condition with some of the symptoms of adrenal insufficiency (though milder) but with normal laboratory tests.

Differential Diagnoses

Other conditions that may cause symptoms sometimes incorrectly diagnosed as adrenal fatigue include:

Treatment

There are no guidelines for the treatment of adrenal fatigue symptoms. Many practitioners recommend healthy lifestyle measures that are beneficial to everyone:

  • Adopting a healthy diet: Reducing carbohydrates and adopting an anti-inflammatory diet may be helpful for some people.
  • Getting regular exercise
  • Quitting smoking
  • Adopting good sleep habits
  • Limiting alcohol intake
  • Practicing stress management
  • Encouraging healthy gut bacteria: Experts are learning that the bacteria that live in the intestines play a role in everything from mood to how well medications work.

Treatments for adrenal fatigue that are recommended by alternative practitioners may or not be helpful depending on the approach. Some providers recommend supplements, and while some may be beneficial for some people, these products are unregulated in the United States and may pose risks.

"Adrenal support supplements" deserve special caution. A 2018 study published in Mayo Clinic Proceedings looked at 12 supplements that were marketed as adrenal support formulas. All of these products contained at least one steroid hormone (such as cortisol, cortisone, or androstenedione), as well as small amounts of thyroid hormone. Researchers noted that long-term use of these products (several months or more) may lead to diabetes, weight gain, and osteoporosis. In addition, due to the way feedback loops function in the body, these supplements could actually lead to adrenal impairment and an adrenal crisis.

It's important to note that if treating apparent adrenal fatigue means that other potentially treatable conditions go overlooked and undetected, the presumption of this diagnosis (and proceeding with its treatment) could be detrimental.

Next Steps

If your doctor has evaluated you for other potential conditions and nothing is found, you may wonder where to turn. Keep in mind that not having a diagnosis does not mean that your symptoms are "in your head." Some conditions are challenging to diagnose. For example, the average person who is diagnosed with an autoimmune disorder has been seeking treatment for over four years and has seen four or more doctors.

If you have symptoms consistent with adrenal fatigue, it's important to find a doctor who is aware that this is not an accepted medical diagnosis, but who also acknowledges your symptoms and the impact they have on your life.

Though these signs of when to seek the advice of a new doctor apply regardless of what you're facing, they are especially relevant when you have a challenging set of symptoms, such as those that define adrenal fatigue:

  • You don't feel confident that you are being taken seriously.
  • You doctor doesn't seem willing to work with you to resolve your symptoms, even if a precise diagnosis cannot be made.
  • Your doctor is not eager to admit to not yet confirming a proper diagnosis and doesn't seem open to working with you to find one.
  • Your doctor is not open to talking about alternative/complementary medicine options such as yoga and meditation.

A Word From Verywell

While researchers, over time, have discovered much about the human body, there is a lot that is still unexplained. If you are experiencing these symptoms, remember that while adrenal fatigue is not a formal diagnosis, there is a reason behind why you're feeling the way you do. Commit to doing what you can, in working with your doctor, to find it. Though that may take time, and you may need to experiment with different treatment approaches along the way, you deserve to feel better.

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