While the doctors interviewed for the article deserve credit for stressing the importance of validating patients’ concerns, the rest of the article could be summarized as this: Adrenal fatigue is not backed by science, but rather constitutes some arbitrary diagnosis concocted on the internet. This opinion is worth a response, as it is not based on a thorough review of the literature nor is it consistent with clinical findings in those being treated for adrenal issues by practitioners who understand the complexity of the hypothalamus-pituitary-adrenal axis.
Additionally, any person(s) who alludes to the science being settled on any particular issue should be viewed with skepticism. And that is essentially what the author and interviewees in this article do.
Science is a continual journey of discovery – adjustments are made to current beliefs as new findings are made. Many findings in the field of medicine that are now well-accepted were first rejected fiercely. This is an important phenomenon to keep in mind when evaluating health information.
In many disease states, factors like severity and speed of disease progression occur on a spectrum. Why, then, would it be any different with adrenal function?
There is no evidence showing that extremes in adrenal dysfunction such as very high cortisolism (Cushing’s Syndrome) or very low cortisolism (Addison’s Disease) are the only ways in which the adrenal glands can malfunction. In fact, it’s not consistent with what we know about the body always fighting to maintain homeostasis.
It makes much more logical sense to consider that milder forms of adrenal dysfunction falling somewhere between Addison’s and Cushing’s would not only be possible, but also very common – particularly among the chronically ill whose bodies are under prolonged physical and emotional stress.
Aside from whether or not it’s logical to consider adrenal fatigue as a legitimate diagnosis, there is perhaps the bigger argument of research-based evidence that has been overlooked by the authors and interviewees of this Endocrine News article.
In 2008, Dr. Holtorf authored an article in The Journal of Chronic Fatigue Syndrome which addressed some of the confusion regarding hypothalamus-pituitary-adrenal axis dysfunction seen in those with fibromyalgia (FM) and chronic fatigue syndrome (CFS). One of the reasons why adrenal fatigue may be dismissed by many medical practitioners is the lack of sensitivity associated with current standard testing.
For example, standard testing of basal cortisol levels cannot adequately assess for HPA-axis function during stress, which is where dysfunction occurs in those with FM and CFS. 24-hour urinary cortisol testing is more sensitive but many of the studies employing this type of testing are small, limiting the significance of the findings. Even so, the majority of these studies show obvious dysfunction in these patients compared with the general population. And even standard ACTH testing shows dysfunction in 50% of this population, which means that accounting for the lack of sensitivity to central HPA-axis dysfunction makes the percentage closer to 100% in these patients.
What is even more mind-boggling is that all testing using IST, CRH, and metyrapone, which are widely accepted by endocrinologists, show dysfunction in nearly all patients in this population. So why then is it not being recognized?
While the type of HPA-axis dysfunction may vary among patients due to the highly complex nature of this system, to vehemently dismiss one of the key underlying imbalances in these patients is ignorant and irresponsible – especially because these patients almost always experience symptoms consistent with low adrenal function such as low blood pressure, fatigue, and dizziness upon standing.
If you are chronically ill and suspect you may have adrenal fatigue or some other type of adrenal dysfunction, find a practitioner who understands the complexity of this topic and is willing to explore the possibility through proper testing and interventions rather than pretending that the problem does not exist – because it clearly does and those who are getting adequate treatment are the ones getting well.
Low dose cortisol, in the context of an integrative approach, has been shown to be even more effective and safer than standard medications prescribed to treat symptoms of CFS and FM. Results speak for themselves. In this case, we have both research and results.
Yes, more work needs to be done for a more thorough understanding of the complex nature of the adrenal glands, stress hormones, and their relationship to chronic illness. But considering the low risk of treatment, there is no good reason for healthcare practitioners to deny patients treatment, especially considering it is becoming the standard of care among those who specialize in disorders such as CFS and FM.
For even more information on the adrenals, read this!