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What is adrenal fatigue?
The adrenal glands are very small organs that sit on top of each kidney. These glands are essential as they produce hormones that your body requires to thrive. One of these hormones is cortisol, which is released in response to stress. Some integrative and naturopathic practitioners, who take a holistic but non-conventional medical approach, have suggested chronic or excessive stress may overwork the adrenal glands and affect their ability to function normally – this phenomenon is referred to by some as “adrenal fatigue”. To clarify, integrative practitioners often have no formal medical training and are typically not considered traditional doctors.
It is important to understand that disorders of the adrenal glands do exist, however, adrenal fatigue is not a diagnosis recognised by medical professionals. This is due to a lack of evidence-based research to support the existence of adrenal fatigue. The Endocrine Society, the largest endocrine organisation in the world, has stated that adrenal fatigue is not a legitimate diagnosis. Members of the organisation are becoming increasingly concerned that if a person is misdiagnosed with adrenal fatigue this may dissuade them from seeking further medical advice, delaying, or preventing an accurate diagnosis from being made. As a result, most endocrinologists and scientists that specialise in glandular and hormonal conditions strongly question the value of adrenal fatigue testing. Specialists have also expressed increasing concern regarding potential treatments for adrenal fatigue, for example, some patients may choose to take self-administered cortisol which can pose a significant health risk when done without professional supervision and guidance.
What are the common symptoms?
Common symptoms that may be associated with “adrenal fatigue” by alternative practitioners are persistent tiredness, fatigue and/or difficulty managing stress. Other symptoms commonly associated are:
- Generalised aches
- Dry skin
- Fluctuations of weight
- Sleep disturbances
- Gastrointestinal problems
If you find that your practitioner has recommended you undergo testing for adrenal fatigue, it is important to seek conventional medical advice as well. Unnecessary testing may prove to be costly and ultimately require patients to undergo further testing to obtain an accurate but delayed diagnosis.
How is adrenal fatigue ‘diagnosed’?
If a patient chooses to undergo adrenal fatigue testing, practitioners will routinely test for several hormones, with a primary focus on cortisol levels. Cortisol levels have a natural diurnal variation over 24 hours and can be influenced by other hormones circulating within the body. Therefore, your practitioner may also choose to test for these hormones as well, as part of an adrenal fatigue test.
Cortisol is a natural steroid produced by the adrenal glands. Cortisol levels can be tested using blood, urine, or saliva samples. Levels may fluctuate in response to stress, this is due to the brain releasing a hormone called adrenocorticotropic hormone (ACTH). ACTH causes the adrenal glands to produce cortisol and adrenaline. This is a normal part of your body’s natural stress reaction.
Thyroid-stimulating hormone (TSH)
TSH is produced by the pituitary gland in the brain. This hormone, in turn, stimulates the thyroid gland to produce triiodothyronine (T3) and thyroxine (T4), which are required for normal bodily function. TSH is routinely tested to establish if your thyroid is over or underactive.
The majority of T3 is bound to proteins, however, we can detect any T3 circulating freely in the blood (FREE T3). This can help doctors to identify potential thyroid or pituitary dysfunction.
Similarly, T4 can also be bound or free, we can measure free T4 circulating in the blood and like free T3 it can help doctors identify pituitary and thyroid dysfunction.
ACTH is also produced by the pituitary gland within the brain and is responsible for regulating cortisol levels. A blood test can be conducted to obtain an ACTH level which can help identify adrenal, pituitary or ectopic pathologies.
It is important to differentiate between adrenal fatigue and adrenal insufficiency. Adrenal insufficiency is a widely recognised, treatable, medical diagnosis supported by extensive scientific research. Adrenal insufficiency can be divided into three subtypes: primary, secondary, or tertiary. Primary adrenal insufficiency is commonly referred to as Addison’s disease. Adrenal insufficiency typically occurs due to the cortex (the outermost layer) of your adrenal glands becoming damaged. Damage to the cortex of the adrenal glands impairs the production of steroid hormones which can lead to a deficiency.
Addison’s disease results in low cortisol and aldosterone levels and both require replacement with glucocorticoid and mineralocorticoid steroids, such as hydrocortisone and fludrocortisone.
Secondary adrenal insufficiency is more common than Addison’s and occurs when the pituitary gland does not stimulate the adrenal glands to produce cortisol.
Symptoms of adrenal insufficiency may be insidious and commonly include:
- Decreased appetite
- Unintentional weight loss
Other symptoms the may be associated with adrenal insufficiency include:
- Low blood pressure – causing light-headedness when standing
- Muscle pain
- Joint pain
- Skin pigmentation of the face, neck or back of hands
- Pigmentation of the buccal mucosa
Tertiary adrenal insufficiency is caused by the reduced production of corticotropin-releasing hormone by the hypothalamus, resulting in decreased ACTH production.
Adrenal Insufficiency can be diagnosed via special stimulation tests and blood tests that analyse the level of early morning cortisol and other hormones produced by your adrenal and pituitary glands within your bloodstream.
It can be frustrating to have symptoms that your doctor may not be able to initially explain or diagnose. However, it is very important to understand that accepting an unrecognised medical diagnosis without seeking further advice will only prevent you from receiving an accurate diagnosis. Consequently, this will mean you are not addressing the real cause of many of your symptoms, which could be caused by a variety of other readily treatable physiological or psychological conditions. It is therefore vital that you always consult a qualified medical professional who can work with you to thoroughly investigate your symptoms to determine an accurate diagnosis and implement an effective and safe treatment plan. It is important to understand that all the symptoms, which can be non-specific, does not only attribute to the adrenal gland and other conditions (non-endocrine) need to be considered if endocrine causes have been excluded.
Written by Dr Candy Sze, Consultant Endocrinologist and specialist in adrenal disorders and diabetes.