“It’s increasingly being told to people that they have this diagnosis and to go see an endocrinologist,” says Dr. Rao. But here’s the thing that Dr. Rao and other endocrinologists must gently tell these people: Adrenal fatigue isn’t actually a real medical condition. In fact, there is no official medical diagnosis for adrenal fatigue. The Endocrine Society, which is a professional organization for people working in the field of endocrinology, doesn’t mince words, stating that “no scientific proof exists to support adrenal fatigue as a true medical condition.” And a systematic review of 58 studies published in the journal BMC Endocrine Disorders also found no substantiation for adrenal fatigue. So, what could it be?
The theory behind adrenal fatigue
The theory behind adrenal fatigue is that your adrenal glands, which sit above your kidneys and produce a hormone called cortisol in response to stress, get burned out from constant stress. They can’t keep up with all the stress, and so they can’t produce enough cortisol. And then you feel crummy. “However, there is absolutely no evidence that chronic emotional or mental stress should render your adrenal glands unable to make cortisol, which is the main stress hormone,” says Dr. Marilyn Tan, MD, clinical chief of the Stanford Endocrinology Clinic. Plus, some of the treatments, including supplements, that people turn to in an attempt to ward off their symptoms are concerning to both Dr. Tan and Dr. Rao.“Those supplements are not regulated and they’re usually very expensive, and they’re usually not covered by insurance,” says Dr. Tan. And in the case of one supplement that some people turn to, bovine adrenal extract, they may actually be harmful. Adrenal extract that’s taken from cows (and possibly other animals) could lead to an actual medical condition called adrenal insufficiency, according to Dr. Tan. “The concern with bovine adrenal extract is that it may have active ingredients that suppress the body’s own endogenous production of cortisol,” she says. Plus, if the bovine adrenal extra contains high levels of glucocorticoids, that could lead to excess levels of cortisol and a condition called Cushing’s syndrome. That can lead to weight gain, high blood pressure, elevated blood sugar levels, mood changes and other symptoms.
Could you have adrenal insufficiency instead?
Could you think you have adrenal fatigue but actually have the condition known as adrenal insufficiency? “Certainly, it’s possible because the symptoms of adrenal fatigue do cross over into the symptoms of adrenal insufficiency,” said Dr. Tan. Adrenal insufficiency develops when your adrenal glands don’t make enough steroid hormones, which are hormones that affect metabolic processes in your body, like cortisol. When you have adrenal insufficiency, there’s not enough cortisol circulating in your body. (There are several different kinds, but all basically have the same end result: not enough cortisol.) As a result, you may have chronic fatigue, muscle weakness, and abdominal pain. You might lose your appetite and begin to lose weight. You might experience some gastrointestinal symptoms, like nausea, diarrhea and vomiting. So, if you’re experiencing those symptoms, your doctor might suggest some bloodwork, especially if you recently stopped taking a corticosteroid after a long time. The bloodwork will include a blood test called an ACTH stimulation test to stimulate your adrenal glands to try to produce cortisol so your doctor can measure the amount in your bloodstream twice. “Based on the blood levels, we are able to determine if they are having adrenal insufficiency or not,” says Dr. Rao. There may be other follow-up tests to determine the cause, which can affect the treatment your doctor recommends for you. You will likely need some sort of hormone replacement therapy. Here’s the danger of not getting treatment for adrenal insufficiency if you actually have it: your symptoms can suddenly get worse, throwing you into a dangerous situation called an adrenal crisis. Your blood pressure and blood sugar levels could drop dangerously low, among other complications. You would need immediate medical care, usually in the form of a corticosteroid shot. You’re more vulnerable to an adrenal crisis when you’re undergoing physical stress. An accident, an illness, an infection, even surgery, can send you into an adrenal crisis. That’s because your body needs even more cortisol than usual during those times of stress.
What to do about adrenal insufficiency
So, what should you do if you’re concerned about the effects of stress on your body? You’re feeling fatigued, you have body aches, you just don’t feel right, but you’re not entirely sure what’s wrong. What’s the right step to take? “Don’t hesitate to go talk to your primary care doctor,” says Dr. Rao. If your doctor thinks you might have adrenal insufficiency, a blood test can confirm it, and you can begin treatment. If you don’t have adrenal insufficiency, you might benefit from some other types of care that can help you feel better, including mental healthcare and some lifestyle changes. Sometimes, positive changes to your diet, regular exercise, and sleep can make a big difference in how you feel, Dr. Rao says, adding, “I’m also a big believer in the power of meditation. I think that really helps.” Next up, if you’re gaining weight despite regular exercise and a healthy diet, here’s what might be going on.
Sources
Dr. Marilyn Tan, MD, clinical chief of the Stanford Endocrinology ClinicDr. Pratibha Rao, MD, MPH, endocrinologist at Cleveland ClinicThe Endocrine Society:“Adrenal Fatigue"The Endocrine Society: “Adrenal Insufficiency” BMC Endocrine Disorders: “Adrenal fatigue does not exist: a systematic review.” Clinics in Laboratory Medicine: “Steroid hormones: relevance and measurement in the clinical laboratory.” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): “Symptoms and Causes of Adrenal Insufficiency & Addison’s Disease.”
