Adrenal Fatigue is Not a Recognized Medical Condition
"Adrenal fatigue" is not a recognized medical diagnosis and lacks scientific substantiation, despite its popularity in alternative medicine circles. 1
What People Call "Adrenal Fatigue"
The term "adrenal fatigue" has been used to describe a collection of nonspecific symptoms including:
- Fatigue
- Body aches
- Sleep disturbances
- Digestive problems
- Nervousness
- Weight changes
Proponents claim these symptoms result from chronic stress causing the adrenal glands to produce insufficient cortisol. However, this concept has been systematically evaluated and rejected by medical science.
Scientific Evidence
A comprehensive systematic review published in BMC Endocrine Disorders (2016) examined 58 studies and found:
- No substantiation that "adrenal fatigue" exists as a medical condition
- Conflicting results across studies regardless of methodology
- Poor quality assessment of fatigue in most studies
- Inappropriate conclusions regarding causality 1
The review concluded that "adrenal fatigue is still a myth" and lacks scientific validity.
Real Adrenal Conditions That Cause Fatigue
It's important to distinguish the unsubstantiated "adrenal fatigue" from legitimate adrenal conditions:
1. Adrenal Insufficiency
- Primary adrenal insufficiency: Autoimmune destruction, congenital adrenal hyperplasia, infections, or surgical removal of adrenal tissue
- Secondary adrenal insufficiency: Disorders affecting the pituitary gland
- Glucocorticoid-induced adrenal insufficiency: Caused by administration of supraphysiological doses of glucocorticoids 2
2. Symptoms of True Adrenal Insufficiency
- Fatigue (50%-95%)
- Nausea and vomiting (20%-62%)
- Anorexia and weight loss (43%-73%)
- Hypotension
- Electrolyte abnormalities 2
3. Diagnosis of True Adrenal Insufficiency
- Early-morning serum cortisol measurements
- Corticotropin (ACTH) levels
- Dehydroepiandrosterone sulfate (DHEAS) levels
- Corticotropin stimulation testing when necessary 2
HPA Axis Dysregulation vs. "Adrenal Fatigue"
While "adrenal fatigue" is not recognized, legitimate HPA axis dysregulation can occur:
- Dysregulation of the hypothalamic-pituitary-adrenal axis can be associated with fatigue conditions
- Diurnal cortisol patterns may be disrupted in certain conditions
- Lower cortisol levels have been linked to increased inflammatory markers in some fatigued individuals 3
Common Pitfalls in "Adrenal Fatigue" Diagnosis
Misattribution of common symptoms: Fatigue is reported by up to 20% of patients seeking primary care and has numerous potential causes 4
Inappropriate testing: Many "adrenal fatigue" tests use unvalidated methods not endorsed by endocrinologists 1, 5
Overlooking legitimate conditions: True adrenal insufficiency, while rare, can be missed when symptoms are attributed to depression or other conditions 6
What To Do If You Have Fatigue
If you experience persistent fatigue:
- Seek evaluation from a licensed healthcare provider
- Undergo appropriate testing for medical conditions that cause fatigue
- Be wary of practitioners who diagnose "adrenal fatigue" and recommend supplements to "support adrenal function" 5
Bottom Line
Medical science does not support the existence of "adrenal fatigue." Persistent fatigue warrants proper medical evaluation for recognized conditions, including true adrenal insufficiency when clinically indicated. Supplements marketed for "adrenal support" lack scientific evidence for their efficacy.