Adrenal Fatigue: Myth or Medical Condition?

In today’s day and age, it’s common for people to rush to the internet whenever signs and symptoms of an illness or disorder are present. Sometimes, the symptoms fit nicely into a diagnosis. Other times, a trip to the doctor’s office is needed to ease your mind.

Between the stress of COVID-19 and disruptions in people’s social life, many are wondering why they feel constantly tired, have zero energy and are always fatigued. The answer to these problems isn’t always as simple as you had hoped for, although patients always want concrete answers. 

To suffice these answers, there is a theory these symptoms of lethargy may be tied to something called adrenal fatigue. But is adrenal fatigue an actual medical condition or is it more of a myth with limited scientific backing behind it? We’ll explore this topic and provide suggestions to help you get answers to your medical questions.

What is adrenal fatigue?

Adrenal glands, which are located on top of your kidneys, produce hormones that help your body balance stress, regulate your metabolism and control your immune system.

Your adrenal glands produce hormones such as:

• Cortisol
• Aldosterone
• DHEA and androgenic steroids
• Epinephrine (adrenaline)
• Norepinephrine (noradrenaline)

Of these hormones, cortisol plays a key role in many body functions. Many people associate cortisol with stress, as it is released during the fight-or-flight response. However, it is also responsible for combating inflammation, controlling blood pressure, boosting glucose levels and helping the body use fats, proteins and carbohydrates.

In a healthy person, the release of cortisol occurs during a series of events that includes the adrenal glands. The process is initiated in the brain’s hypothalamus, when corticotropin-releasing hormone (CRH) signals to the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH then signals your adrenal glands to make and release cortisol.

The belief with adrenal fatigue is that stress and fatigue overwork the adrenal glands to a point where they no longer effectively produce hormones. The state of low hormonal activity would then lead to symptoms such as brain fog, mood swings, trouble sleeping and fatigue.

Is adrenal fatigue a medical diagnosis?

The problem many medical experts have with the term adrenal fatigue is that it isn’t an accepted medical diagnosis. Instead, it’s more of a general term some doctors use as a diagnosis to label unexplained symptoms.

In 2016, a comprehensive review conducted by the BMC Endocrine Disorders, a peer-reviewed medical journal, found adrenal fatigue is still a myth. Further, the Endocrinology Society also doesn’t recognize adrenal fatigue as a condition. The reasoning is simple: In times of stress, cortisol production actually increases, not decreases. Plus, organs and glands are resilient and constructed to withstand large tasks. The heart is a primary example – it beats about 35 million times a year.

Most medical complications that stem from adrenal gland issues actually result in excess production. For example, Cushing syndrome occurs when too much cortisol is produced, and pheochromocytoma occurs when too much adrenaline is produced.

In rare cases, adrenal insufficiency may be the cause.

Adrenal fatigue vs. adrenal insufficiency

Adrenal fatigue can sometimes be confused with adrenal insufficiency, which is an actual medical disorder. With this condition, the adrenal glands don’t make enough hormones due to certain medical conditions such as an autoimmune disease. 

Adrenal insufficiency can either be primary or secondary. Some cases of adrenal insufficiency are caused by Addison’s disease, a rare disease in which the adrenal glands don’t make enough cortisol and aldosterone. You can also have secondary adrenal insufficiency in which the pituitary gland doesn’t make enough adrenocorticotropin (ACTH), a hormone that controls the production of cortisol.

The symptoms are even similar – fatigue, muscle weakness and weight loss. But, unlike adrenal fatigue, adrenal insufficiency has definitive tests to make a diagnosis.

An ACTH blood test is the most common way doctors determine if you have adrenal insufficiency. An IV injection of synthetic ACTH is administered to gauge how cortisol responds – if the levels remain the same or increase very little, you likely have an insufficiency. 

If this test is unclear, your doctor can order an insulin tolerance test to test your pituitary gland function. As part of the test, an insulin injection lowers your blood glucose levels to trigger hypoglycemia. During a state of hypoglycemia, the pituitary gland should make more ACTH to combat the stress placed on your body. In turn cortisol levels should rise. However, if cortisol levels don’t rise during or after the test, an insufficiency is suspected.

What should you do?

Constantly feeling tired, lethargic or experiencing mood swings can be maddening. While you may want a quick answer and diagnosis, the reality is these symptoms can be a number of things – many of which have nothing to do with your adrenal glands.

For starters, a poor diet can leave you craving sugary and salty foods and poor sleeping habits may result in a chronic state of being tired. The truth is, it could be any number of issues, ranging from a simple infection to more serious issues with your major organs – heart, lungs, kidneys or liver. Even mental health disorders, such as anxiety or depression, can produce these symptoms.

While not as common, your medical problems may be a sign of postural orthostatic tachycardia syndrome (POTS), a condition that leads to reduced blood flow when you stand up. The lack of blood volume can make you feel lightheaded or increase your heart rate.

If your doctor suspects any problems with your adrenal glands, they can conduct an ACTH test, check your thyroid to rule out hypothyroidism (underactive thyroid) or conduct an A1C test to check for type 2 diabetes or prediabetes.

Getting a full workup before a diagnosis is important because some doctors may treat adrenal issues with cortisol steroid injections. However, pumping your body with cortisol can actually have negative consequences, such as weight gain and heart implications.

Don’t suffer in silence or let these symptoms go unnoticed. Consult with an endocrinologist who is trained to treat disorders related to the hormones your body uses to function. Click here to learn more about our mental health programs. For more wellness content, visit the INTEGRIS Health For You blog.