Tuesday, June 10, 2008
What is adrenal fatigue?
Another unresolved controversy. This diagnosis is not accepted by mainstream medicine. The adrenal gland manufactures and releases hormones, messenger molecules, which have far reaching effects on other areas of the body. The hormone cortisol regulates immune function, brain function, metabolism and many other body processes and functions. The extreme form of adrenal insufficiency is called Addison's disease This due to a primary failure of the adrenal gland to produce cortisol. The other accepted form of adrenal insufficiency is called secondary adrenal insufficiency. This is mostly associated with excessive use of adrenal cortico-steroids, like Prednisone, which has caused the body to decrease its own production of cortisol. Serum cortisol do not correlate with cortisol deficiency since most of the hormone is bound to tissues. The ACTH challenge is used to make the diagnosis. The adrenal stimulating hormone made by the pituitary gland in the brain is administered by injection. The amount of cortisol is measured to see if the adrenal gland has the "reserve" ability to respond appropriately to this stimulus. Proponents of adrenal fatigue argue that this test is insensitive. They instead do a saliva test, which generally shows low levels of cortisone and confirms their hypothesis. The test is not accepted by mainstream medicine. The adrenal gland makes several hormones. It does respond to stress. These hormones have been called stress hormones. Severe physical stress can place demands on the adrenal gland which exceed its ability to act. Severely ill patients with overwhelming sepsis for example, can experience acute adrenal insufficiency requiring supplementation. There is the notion that chronic stress leads to low level adrenal fatigue. This has been associated with low energy, fatigue, depression, pains and other symptoms which dovetail with those seen in chronic Lyme. The administration of cortisol like medications does give people an enhanced sense of well being and increased energy. The down side is that these steroids have many side effects and cause long term harm to the patient; and the long term use of these drugs can ironically cause adrenal insufficiency, they very disease they are supposed to be treating. Some people take DHEA, a precursor steroid molecule. Measurements of this hormone are sometimes used as a surrogate marker for adrenal fatigue. There is no evidence that this correct. Levels of DHEA normally decrease with age. The levels are quite variable. The use of this supplement is known to give people more energy and is common in Europe. We do not know what the long term consequences of this medicine are. I am sure that chronic illness and stress can require excess production of adrenal stress hormones. I do not know if adrenal fatigue is real or not. If it is, the best way to treat it might be to eliminate the underlying causes. If chronic infection with Lyme is the cause then perhaps effective treatment is to allow the adrenal function to improve naturally. Emotional stress should be minimized. Proper nutrition, rest and exercise should be encouraged. Patients who are profoundly fatigued may judiciously be given cortisol for short periods of time. But in general I am leery of this unproven approach.