Complimentary Story
October 2025Having been in medicine a long time, one starts to realize that there are trendy diagnoses that show up every so often. Some of these are from within the allopathic community, but most come from alternative sources. One of those trendy diagnoses right now is adrenal fatigue. That sounds terrible. Aren’t the adrenal glands important? Shouldn’t we want them to be full of energy and not fatigued? Hey, wait, what are the adrenal glands anyway?
Let’s start with that last question. The adrenal glands produce four hormones. These two glands look a bit like stocking caps and sit on top of the kidneys. They are not connected to the kidneys, just located next to them. There is an inner and an outer layer that produce two different hormones in each layer. Their job is to produce hormones; adrenaline, noradrenaline, cortisol and aldosterone. These hormones are important for blood sugar regulation, metabolism, sex hormone production, salt and water regulation and our response to stress. The adrenal glands can certainly fail, but due to redundancy, that is a pretty uncommon condition.
Blood tests for the adrenal hormones are still the standard of care. These tests can be a bit tricky as some require testing to be drawn at specific times to be most useful. Often when I have someone coming in with the complaint of adrenal fatigue, they have done salivary testing that has been obtained from some other source. Salivary testing is more convenient for the patient as it is done at home. Unfortunately salivary testing is not very accurate as to the state of the adrenal glands. Does the test accurately measure the amount of hormone in the saliva? Yes. But that does not translate into blood levels that precisely assess the health of the adrenal glands.
So, what is adrenal fatigue? (Because it sounds like a really bad thing.) The theory about the cause of this condition is that chronic stress causes the adrenal glands to stop making enough of the stress hormones that our body needs. Symptoms include tiredness, muscle and joint aches, brain fog, craving sweets, sleep problems, weight gain and difficulty coping with stress. Wait…What? I thought that was chronic Lyme disease. No wait…chronic fatigue syndrome. No wait…fibromyalgia. No wait…long COVID. I am so confused right now.
There is no doubt that the adrenal gland can fail. When that happens it has devastating effects. Addison’s disease, a deficiency of cortisol, has many of the same symptoms as adrenal fatigue. Maybe that is where the confusion sets in for this term Adrenal Fatigue as it is not a medical diagnosis. Sudden discontinuation of steroids after prolonged use can lead to a syndrome that mimics loss of cortisol Prednisone, a common anti inflammatory medication for things like rheumatoid arthritis, allergic reactions or breathing problems, can lead to a temporary reduction in the function of the adrenal glands. This type of steroid can replace some of the hormones that the adrenal glands make so they feel like they can go on vacation. Topical steroids can cause similar issues too, but that takes a lot of product to cause trouble.
Now, if you have read this far, please notice I did not say that these patients have imaginary symptoms. Symptoms are real. These symptoms can represent serious disease and an appropriate work up should be conducted. A minimum, work up should include a blood count, chemistry profile, sedimentation rate or CRP and for men a testosterone level. Depending on the exact complex of symptoms additional testing may need to include a Lyme titer, rheumatoid factor, ANA, AM cortisol and Vitamin B12. Diagnoses like sleep apnea, diabetes, rheumatoid arthritis and testosterone deficiency are some of the many conditions that can have these same symptoms. Additional disease specific testing may need to be conducted as well. Presumably, patients have already gone through testing to prove that they do not have any of these serious conditions. Simply jumping to the conclusion of the “diagnosis” without doing a workup is malpractice.
Generally speaking, the treatments offered to patients are supplements. It seems like each practitioner that make this diagnosis treats their patient with a different recipe of supplements. I have no problems with taking supplements. I may not understand all of them or their reported benefits, but supplements can be useful. Vitamin and minerals are FDA regulated products. Most everything else is considered a food item and is not subject to regulation so the consumer is left to trust the producer that they have adhered to quality and safety standards. When I review some of these lengthy lists of supplements, I simply see dollar signs. I especially have concerns when patients have supplements that only the practitioner can provide as well as proprietary products. Basically, proprietary means “I put a bunch of stuff in this potion and you can’t know what is in it.” This fostering of dependency on the practitioner to treat the condition just seems wrong. But doctor, isn’t that how the allopathic world works? A little, but you can go to any Family Medicine doctor and get these, or similar, prescriptions. The patient is never locked into one doctor.
Chronic stress affects so many areas of our lives. It disrupts our sleep. It affects our emotions and ability to interact with others around us. It can cause high blood pressure. It can lead to a variety of stomach issues as well. Nope, I don’t have the answer about how to deal with chronic stress, sorry. That is something that only you can figure out. Whatever it is, just make sure you have the parachute properly secured to your person before jumping out of the airplane.
GenesisPrimaryCare.com
