What is Adrenal Fatigue?
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Adrenal Fatigue

Are you tired of feeling tired? Do you still feel sluggish even after a good night’s rest? So many of us go through our daily activities feeling stressed, overwhelmed, fatigued, irritable, and experiencing mental fog. These symptoms could indicate that your adrenal glands may not be performing well enough to keep your body functioning at a healthy level. A person diagnosed with Chronic Fatigue Syndrome, Fibromyalgia, as well as, women experiencing perimenopause and menopause, can be particularly susceptible to adrenal imbalances.

Many health experts believe approximately 80% of the population suffer from some level of adrenal insufficiency yet are only diagnosed when an extreme deficiency (Addison’s disease) or overproduction (Cushing’s disease) of the adrenal hormones are found while performing routine blood work. This means that many people are trying to manage their lives and daily activities with malfunctioning adrenal glands, which goes undetected, not meeting the level of severity to diagnose disease. When your adrenal glands are being stressed, an autoimmune inflammatory response can occur throughout the entire body.

Often these adrenal malfunctions cannot be addressed with just a healthy diet and exercise. And while exercise is a very important part of being healthy, if not done properly for your level of health, can trigger an adrenal crash.

We Can Help You!

Doctors here at Holtorf Medical Group are specially trained to diagnose and treat adrenal dysfunction. For more information on adrenal fatigue, consult with your doctor or speak with a patient representative at 877-508-1177.

What Are Adrenal Glands?

The adrenal glands are no bigger than a walnut and sit directly on top of your kidneys. They produce more than 150 different hormones which include adrenaline (epinephrine), cortisol, estrogen, progesterone, dehydroepiandrosterone (DHEA), and many more. Cortisol is the most important anti-stress hormone produced by the adrenal glands. Cortisol, otherwise known as the “fight or flight” hormone, is secreted within the body when a major stressor occurs, or a threat of impending harm is experienced.

Many other essential hormones are produced by the adrenal glands which aid in converting carbohydrates, protein and fat into blood glucose for energy. These hormones also maintain fluid and electrolyte balance, as well as, facilitating the storage of fat in your body.

Major functions of the adrenal glands which protect our bodies include:

  • normalizes blood sugar
  • provides anti-inflammatory response
  • regulates immune system
  • balances blood pressure
  • improves tolerance of stress

What Causes Adrenal Fatigue?

In today’s world, life can be downright stressful! Adrenal dysfunction is common and many of us move through life not feeling as good as we could. Here are some common causes and triggers we encounter which can cause adrenal fatigue.

  • Acute life stressor (death of a loved one, divorce, loss of job, etc.)
  • Accident or surgery
  • Prolonged emotional and life stress
  • Diagnosis of Chronic Fatigue Syndrome or fibromyalgia
  • Hormone Imbalance in perimenopausal/menopausal women
  • Acute respiratory illness such as bronchitis or pneumonia
  • Ongoing bacterial/viral infections
  • Long term insufficient amount of good quality sleep

What Are the Symptoms of Adrenal Fatigue?

Symptoms of adrenal fatigue can progress very slowly and are often ignored, until a stressful event such as illness or an accident occurs, causing symptoms to worsen. Sudden and severe worsening of symptoms is considered an Addisonian Crisis or acute adrenal insufficiency.

Symptoms you may be experiencing indicating poor adrenal function could be:

  • Inability to handle stress
  • Decreased sex drive
  • Chronic or worsening fatigue, not relieved by adequate sleep or rest
  • Insomnia
  • Moodiness
  • Exhausted after exercise (feeling wiped out)
  • Muscle weakness
  • Dizzy when standing (low blood pressure)
  • Brain “fog”
  • Crave sugar or salty foods
  • Swollen ankles which worsen at night
  • Recurrent infections
  • Loss of appetite (weight loss)
  • Food sensitivities
  • Inability to tolerate thyroid replacement therapy

How Is Adrenal Fatigue Diagnosed?

The ACTH stimulation test is most commonly used for diagnosing adrenal insufficiency. This is done by measuring the levels of cortisol in your blood and urine before and after receiving an injection containing a synthetic form of adrenocorticotropic hormone (ACTH). This is a hormone produced by the pituitary gland that stimulates the adrenal glands to produce cortisol.

A normal response after an ACTH injection would be a rise in blood and urine cortisol levels. Abnormal response of this test is indicated by very little or no increase in the cortisol levels.

If the response to the ACTH test is abnormal, indicating a deficiency, another test may be performed to help determine the cause of adrenal insufficiency. A corticotropin-releasing hormone (CRH) stimulation test would be performed. This is done by injecting this synthetic hormone (CRH) intravenously, then measuring the blood cortisol levels at 30, 60, 90, and 120-minute intervals, after the injection. If the CRH test does not stimulate any ACTH secretion, this would indicate a damaged pituitary. A delayed secretion of ACTH would point to the hypothalamus as the cause.

An insulin-induced hypoglycemia test can then be done to determine how the hypothalamus, pituitary and adrenal glands respond to stress. During this test, blood is drawn to measure the blood glucose and cortisol levels, followed by an injection of fast-acting insulin. Blood glucose and cortisol levels are measured again at 30, 45 and 90-minute intervals, after the insulin injection. The normal response is for blood glucose levels to fall (this represents the stress) and cortisol levels to rise.

Is Low Dose Cortisol Treatment Right For Me?

Many individuals diagnosed with Chronic Fatigue Syndrome or Fibromyalgia, especially those with symptoms which are consistent with adrenal dysfunction, such as low blood pressure, or baseline cortisol levels in the low to normal range, would benefit from this treatment.

To determine if low dose cortisol treatment could be beneficial for you, please consult your doctor or call 877-508-1177 to speak with a patient representative.


Is Adrenal Fatigue common?
Many health experts believe that as much as 80% of the population suffers from some level of adrenal fatigue, but are only diagnosed when adrenal hormone levels imbalances become severe, such as with Addison’s disease (too little cortisol) or Cushing’s disease (too much cortisol).

Am I at risk for Adrenal Fatigue?
Anyone can be at risk of developing adrenal fatigue. But there are factors that stress or overwork your adrenals and can contribute to increased risk:

  • Severe or chronic emotional or physical stress, including chronic pain or illness
  • Repeated infections, such as bronchitis or pneumonia
  • Regularly pushing your body to its limit, or “burning the candle at both ends”
  • Poor diet, high in sugar, caffeine and junk food
  • Overload of toxins
  • Substance abuse
  • Lack of refreshing sleep and rest
  • Untreated or undertreated thyroid hormone deficiency
  • Smoking – While not a direct cause of adrenal fatigue, smoking can contribute to the body’s toxic load and play a part in adrenal fatigue
  • Hormonal imbalances such as those experienced during perimenopause and menopause
  • Aging - Adrenal cortisol production commonly decreases as we age

Is Hydrocortisone a safe treatment for Adrenal Fatigue?
Yes. For some patients with low cortisol levels, hydrocortisone can be the best treatment option. Dosage is maintained at a “physiological level,” which means the amount given is low enough to not affect the body’s own production of cortisol. For patients with all-day low cortisol, hydrocortisone raises the floor of cortisol levels throughout the day, so that these levels can be closer to normal/optimal.

Can Adrenal Fatigue become chronic?
If a patient is experiencing decreased adrenal function and the accompanying low cortisol levels, the use of cortisol and adrenal support supplements may be required, in addition to behavior and lifestyle changes, to help restore health. If a patient continues to suffer from adrenal fatigue symptoms, then further improvements to diet, sleep hygiene and stress reduction may be needed.

Are Adrenal Dysfunction and thyroid issues related?
Yes, hypothyroidism and adrenal fatigue often go hand in hand. Many patients with adrenal fatigue often also experience issues with low thyroid hormones, or hypothyroidism. Patients who are hypothyroid and are not responding adequately to thyroid hormone replacement therapy should have their adrenal cortisol levels tested to rule out adrenal fatigue, and should support their adrenals as part of their overall treatment plan.

What if my doctor says, "Adrenal Fatigue isn't real?"
Low adrenal function related to physical and emotional stress was recognized more than 100 years ago and has been successfully treated for decades. Unfortunately, many conventional doctors do not recognize under-functioning adrenals and will not provide treatment until a patient is at the severe end of the spectrum, with either Cushing’s disease or Addison’s disease. By properly testing cortisol levels at four key points throughout the day, providing supplemental hydrocortisone if testing levels indicate the need, and improving diet, sleep hygiene and stress reduction/avoidance, patients can enjoy an improved quality of life.

Can a person with Adrenal Fatigue ever feel well again?
Yes. With the right treatment, along with necessary lifestyle and behavior changes, patients with adrenal fatigue can feel well again.

Your doctor will work with you to determine if your adrenal hormone levels are optimal. If needed, he or she will develop a customized treatment plan, including appropriate medications and supplements, to allow you to regain your health.


Adrenal Hormones 101
Adrenal Fatigue Testing
Adrenal Fatigue Treatment Options