One of the most common reasons patients seek help from a doctor are feeling tired and having low energy. Fatigue is a vague symptom with a broad range of causes, including acute and chronic medical disorders, psychological conditions, medication toxicity and substance use.
The term “fatigue” has been used to describe a sense of weakness, getting tired easily, difficulty with concentration and memory, a depressed mood or sleepiness or an uncontrollable need to sleep. Patients may report one or a combination of these symptoms and they may occur alone or with other complaints.
Despite being so common, it is often challenging to come up with a diagnosis, as many medical problems can cause fatigue. Doctors are often like detectives as we interview and examine our patients, trying to put the pieces of the puzzle together with blood tests and other studies.
But often the initial results yield no explanations. It can be frustrating for both doctors and patients when a clear-cut diagnosis remains elusive. This has led to the development of an attractive theory, called adrenal fatigue, that links stress to adrenal exhaustion as a possible cause for this lack of energy.
But is adrenal fatigue a real disease?
The adrenal glands are two small glands that sit on top of the kidneys and produce a variety of hormones essential to life, such as cortisol. When under stress, the body produces and releases short bursts of cortisol into the bloodstream.
If the adrenals don’t produce enough cortisol, this is known as adrenal insufficiency (Addison’s disease) and is a result of an underlying disease. Adrenal insufficiency can be diagnosed by blood tests and special tests that show inadequate levels of adrenal hormones.
Proponents of adrenal fatigue claim this is a mild form of adrenal insufficiency caused by chronic stress. The unproven theory behind adrenal fatigue is that your adrenal glands are unable to keep up with the demands of constantly being stressed. According to this theory, existing blood tests aren’t sensitive enough to detect such a small decline in adrenal function even though you may have symptoms of adrenal insufficiency, thus the normal blood tests.
There are numerous websites, blogs and so-called experts that mention how to diagnose and treat adrenal fatigue, often pushing expensive and possibly harmful treatments. But professional medical societies categorically agree that there is no scientific proof that exists to support adrenal fatigue as a true medical condition, including a recent review of 58 research studies.
But what if I have symptoms of adrenal fatigue?
Before you turn to the internet to diagnose yourself, you should first have a thorough evaluation with your doctor. Fatigue can be caused by many medical conditions — anemia, sleep apnea, depression, autoimmune diseases, infections, other hormonal impairments like hypothyroidism and diabetes, mental illnesses, heart and lung problems, kidney and liver diseases and fibromyalgia, to name a few.
If the workup from your medical professional turns out normal you may be tempted to believe that you might have adrenal fatigue. And it can be exasperating to have persistent symptoms that your doctor can’t readily explain.
To make things worse, it’s not unusual for doctors to say there is nothing wrong with you, or that it is all in your head. Mental health conditions, such as depression or anxiety, may also be the cause of these symptoms. And some patients who do not believe that their fatigue is due to a mental health concern may refuse counseling and medications.
So, what can I do if I still feel this way?
The adrenal fatigue theory may fit like a glove to explain your symptoms, which are very real. But accepting a medically unrecognized diagnosis could be dangerous. Unproven remedies for so-called adrenal fatigue may leave you feeling sicker, while the real cause is left untreated.
An important warning: some unqualified practitioners prescribe steroids to treat adrenal fatigue. Steroids can be dangerous even in small doses and can have unintended consequences such as weight gain, osteoporosis, diabetes and heart disease. And if you take steroids for a prolonged amount of time and stop them abruptly, you can induce real adrenal insufficiency, because the intake of steroids prevents your own adrenal glands from producing cortisol.
Work closely with your doctor, as frequent follow-up visits and a strong patient-doctor partnership are important to get the help you need.
And before buying into a diagnosis that we’re not even sure exists, take a step back and reexamine your lifestyle. It could indeed be that today’s hectic pace has taken its toll on your well-being and managing your stress may be the solution.