The concept of adrenal fatigue or adrenal exhaustion is highly controversial. However, it continues to attract much media attention and there are scores of websites and books dedicated to the subject of adrenal fatigue. There is much debate as to whether many of the signs and symptoms attributed to adrenal fatigue syndrome may not be due to other known medical conditions. Itt is not uncommon for many people to “self diagnose” themselves as having this condition leading to the belief that it prevalent.
The hype around adrenal fatigue detracts from the proper diagnosis of established medical conditions associated with adrenal underactivity or conditions that causes similar clinical features. This includes conditions like depression, diabetes mellitus and thyroid disorders.
The adrenal glands sit on top of the superior pole of each kidney. It has two parts – an inner medulla and outer cortex. The adrenal cortex secretes corticosteroids of two types – mineralocorticoids and glucocorticoids. These hormones are also referred to as adrenocortical hormones. The glucorticoids, of which cortisol is the main type, has received much attention as being the deficient hormone in adrenal fatigue syndrome. In adrenal insufficiency, there may be a deficiency of glucocorticoids and/or mineralocorticoids but this is clinically detectable.
What is Adrenal Fatigue Syndrome?
Adrenal fatigue syndrome is a term used to describe a collection of signs or symptoms attributed to underactivity of the adrenal gland that arises from chronic stress. This means that there is a deficiency of the corticosteroids (steroid hormones), particularly glucocorticoids, secreted by the cortex of the adrenal gland.
These hormones play an integral role in the body’s metabolism – regulates blood glucose levels, maintains blood pressure and the metabolism of carbohydrates, proteins and fats. Without these hormones, integral life-sustaining functions are compromised. The other corticosteroid hormones from the adrenal cortex is the mineralocorticoids of which aldosterone is the major type. Aldosterone helps with water and electrolyte balance and plays integral roles in blood volume and pressure.
With the adrenal fatigue, it is thought that there is slightly lower than normal levels of these hormones and the adrenal gland does not respond appropriately when these hormones are needed in larger quantities. It is therefore believed the underactive adrenal gland leads to the same signs and symptoms as the better understood adrenal insufficiency (hypofunction) although the extent of the deficiency is not to the same degree.
Adrenal fatigue does NOT mean that there are no circulating adrenocortical hormones. Neither does it mean that the adrenal gland is totally unresponsive to factors that stimulate adrenocortical hormone production and secretion.
Adrenal insufficiency, as it is medically known, is either primary or secondary. With primary adrenal insufficiency the adrenal gland is diseased and can therefore not produce and secrete sufficient quantities of glucocorticoids. Mineralocorticoids may also be deficient.
Causes of Adrenal Fatigue Syndrome
It is believed that adrenal fatigue syndrome arises due to chronic stress. When a person undergoes a rapid change in environment or faces emergency situations, the body’s flight-or-flight response takes effect. This involves the secretion of catecholamines from the adrenal medulla for a short-term response and glucocorticoids for a long-term effect. The aim of this fight-or-flight response is to increase the body’s ability to cope and help a person fend off any immediate danger or flee.
Chronic stress causes these hormones to be secreted for long periods of time. It is believed that over time the adrenal glands become less responsive to stimulation. It therefore produces and secretes less glucocorticoid hormones as is needed for optimal functioning. This leads to symptoms of mild adrenal insufficiency which is not clinically detectable by laboratory tests. The level of other adrenal hormones may also be compromised.
Signs and Symptoms of Adrenal Fatigue
It is proposed that many of the signs and symptoms seen with adrenal insufficiency syndromes like Addison disease may also be present in adrenal fatigue syndrome. These non-specific symptoms are usually milder and chronic that in adrenal insufficiency. Some of the signs and symptoms of adrenal fatigue may include
- Persistent fatigue
- Weight loss
- Loss of appetite
- Light headedness or even dizziness
- Low blood pressure
Other signs and symptoms, that may not be present in every case includes :
- Poor memory, mental fog and difficulty with problem solving that was not present previously.
- Cravings for sweet, salty and fatty foods.
- Mild depression or mood swings.
- Diminished libido or total lack of interest in sex.
- Fluctuating energy levels which is pronounced in the morning and afternoon.
- Changes in bowel movements with intolerance to certain foods (may cause diarrhea).
- Menstrual changes
- Muscle weakness