The wellness industry, alternative medicine and even the mainstream media can be highly influential – sometimes propagating public awareness of certain ‘syndromes’ despite very little supporting medical evidence. In this article, it is existence of adrenal fatigue that has captured our attention.
In an era where information is literally at our fingertips, it is not always doctors who are the first port of call when we have a medical complaint. In fact, we have never been more exposed to news of the latest health discoveries and advice from multiple sources, offering all sorts of explanations for our symptoms (and plugging the next best thing that will make us feel better!).
What is Adrenal Fatigue?
Our adrenal glands respond to stress. Adrenal fatigue, also called ‘adrenal burnout’ or ‘adrenal exhaustion’, has been described as a condition of underperforming adrenal glands after a period of extreme stress. The hypothesis is that the adrenal glands become exhausted leading to suboptimal production of the adrenal hormones, in particular the ‘stress hormone’ cortisol.
Modern lifestyles are busy and often overly demanding on our health, leading to what many of us would describe as constant tiredness. The general effects of sleep deprivation and fatigue have negative impacts on our overall health and wellbeing, affecting mood, energy levels and our ability to get through the day.
Proponents of adrenal fatigue imply that such symptoms are in-line with that of lowered adrenal hormone production, but to date there is no clinical evidence to support these claims.
Adrenal fatigue is not recognised by the medical profession, including hormone experts at the Endocrine Society. A recent publication found that studies on adrenal fatigue were inconsistent, of poor scientific quality, did not use medically accepted methods of assessment and inappropriately interpreted results. This rather damning assessment led to the authors concluding that ‘there is no substantiation that “adrenal fatigue” is an actual medical condition’.
Indeed, the reported symptoms of adrenal fatigue are general and not specific to adrenal function, unlike true disorders of the adrenal gland such as adrenal insufficiency (see later). In fact, in contrast to lowered production of cortisol, as implied occurs in stress-induced adrenal fatigue, stress is a factor known to significantly elevate cortisol production. What’s more, is that supplementing with cortisol medication to treat adrenal fatigue can shut-down the production of the body’s adrenal cortisol. Not only does this have the opposite affect than intended, it can result in long-term adrenal problems.
What are the adrenal glands and what do they do?
The adrenal glands are small endocrine – hormone-producing – organs that are located above the kidneys, and receive chemical signals from elsewhere in the body, including the brain. These signals tell the adrenal glands when to produce and release adrenal hormones into the bloodstream. The adrenal cortex produces three different classes of steroid hormones:
Glucocorticoids – Cortisol has many functions including promoting glucose metabolism by the muscle and storage of sugars in the liver, and helping to combat inflammation and boost immunity. The timing of cortisol release is important and is controlled by chemical signals from the brain at specific times of day. Cortisol production is highest in the morning and lowest late at night. Cortisol levels can be measured in saliva either during the morning awakening period, or over the course of the day with the comprehensive cortisol test kit.
Androgens – DHEA, DHEA-s and androstenedione are ‘weak’ adrenal androgens which are mostly converted into ‘strong’ acting sex hormones produced by the adult ovaries and testis, including testosterone, estrogen and progesterone. But adrenal androgens are vital for male and female development in childhood and around the onset of puberty. DHEA-S can be measured in saliva, in combination with cortisol, to assess adrenal function.
Mineralocorticoids – primarily aldosterone, is required for normal kidney function, and the regulation of salt balance, which keeps blood pressure in check.
Adrenal gland disorders
Despite the existence of adrenal fatigue being largely disputed, there are medically-recognised adrenal gland disorders which cause the over or under production of key adrenal hormones.
Cushing’s syndrome occurs when the body is exposed to too much cortisol. In rare cases, it is caused by the presence of a tumour that stimulates the adrenal glands to overproduce cortisol. More commonly, Cushing’s syndrome occurs due to supplementation with cortisol-like steroids (e.g. prednisolone) to treat inflammatory conditions, such as arthritis.
Overproduction of, or overexposure to cortisol, can lead to rapid weight gain, increased thirst and urination, high blood pressure, high blood sugar, insomnia, increased male-pattern hair growth in women, and poor mood. Cushing’s syndrome is more common in women and is treatable.
Adrenal insufficiency is a serious and sometimes life-threatening disorder that was first coined by Thomas Addison in 1855. It occurs when the adrenal glands do not make high enough levels of the three classes of steroid hormones: glucocorticoids, androgens and mineralocorticoids.
The disorder can manifest as a direct problem with adrenal glands themselves (primary) or via the chemical signals that come from the brain (secondary).
Primary adrenal insufficiency
In primary adrenal insufficiency, also known as Addison’s disease, the production of all three adrenal steroid hormones is affected. Primary adrenal insufficiency is caused in rare cases by a tuberculosis infection, but more commonly by abnormal immune function called auto-immune disease.
Signs of primary adrenal insufficiency include weight loss, low blood pressure, low blood sugar, fatigue, muscle weakness and pain, nausea, flu-like symptoms and in some cases increased pigmentation of the skin. It is common to crave salt due to low aldosterone levels which disrupt the body’s salt balance. A reduction in adrenal androgens can also affect the production of the sex hormones, testosterone, estrogen and progesterone.
Secondary adrenal insufficiency
In secondary adrenal insufficiency the chemical signalling from the brain is disrupted and the adrenal glands are not properly stimulated to make cortisol. The production of other adrenal hormone types including androgens and aldosterone are unaffected. Secondary adrenal insufficiency is much more common than primary adrenal insufficiency and tends to arise in older people. The symptoms are largely similar to primary adrenal insufficiency, but without the pigmented skin or salt craving. Secondary adrenal insufficiency is commonly caused by long-term use of cortisol-like supplements which trick the body into reducing its own production.
What are the treatments for adrenal insufficiency?
Once diagnosed by a doctor, treatments include replacement of major adrenal hormones through adrenal supplementation, which may include aldosterone and cortisol. Women may also receive adrenal androgen (DHEA) supplementation as this is the major source of androgens in females. In severe cases, initial treatment can require large amounts of fluids and sugar to rescue the adrenals from crisis.
Some points of reflection:
The symptoms are real. Despite not acknowledging that adrenal fatigue is a real syndrome, medical professionals do accept that the symptoms a patient is experiencing are very real and that healthcare providers should not underestimate this.
See a medical specialist. Your doctor will be able to eliminate potential causes and prescribe appropriate treatments for often reversible symptoms. It may be the case that symptoms are related to other treatable conditions such as low iron, or caused by a hormonal imbalance, such as menopause.
Self-medication should be avoided. Adrenal supplementation should only occur when prescribed by a doctor. Pricey over-the-counter adrenal supplements marketed by the health and wellness industry are often not regulated and therefore could be potentially harmful. They do not typically follow rigorous scientific basis for their promoted health benefits.
Nicolaides N, Chrousos GP and Charmandari E. Adrenal Insufficiency. De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. NCBI Bookshelf. South Dartmouth (MA): MDText.com, Inc.; 2000-. [Last Update: October 14, 2017.]
Cadegiani FA and Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocrine Disorders (2016), 16:48
Seaboard E. The Myth of Adrenal Fatigue. Endocrine News, Endocrine Society (Sep 2017) https://endocrinenews.endocrine.org/myth-adrenal-fatigue/ [accessed 8 December 2017]