Articles

Fatigued by a Fake Disease

One of the realities of being a pharmacist is that we’re easily accessible. There’s no appointment necessary for consultation and advice at the pharmacy counter. Questions range from “Does this look infected?” (Yes) to “What should I do about this chest pain?” to more routine questions about conditions that can easily be self-treated. Part of the pharmacist’s role is triage — advising on conditions that can be self-managed, and making medical referrals when warranted. Among the most common questions I receive are related to stress and fatigue. Energy levels are are down, and patients want advice, and solutions. Some want a “quick fix,” believing that the right combination of B-vitamins are all that stand between them and unlimited energy. Others may ask if prescription drugs or caffeine tablets could help. Evaluating vague symptoms is a challenge. Many of us have busy lifestyles, and don’t get the sleep and exercise we need. We may compromise our diets in the interest of time and convenience. With some simple questions I might make a few basic lifestyle recommendations, talk about the evidence supporting supplements, and suggest physician follow-up if symptoms persist. Fatigue and stress may be part of life, but they’re also symptoms of serious medical conditions. But they can be hard to treat because they’re non-specific and may not be easily distinguishable from the fatigue of, well, life.

This same vague collection of symptoms is called something entirely different in the alternative health world. It’s branded “adrenal fatigue,” an invented condition that’s widely embraced as real among alternative health providers. There’s no evidence that adrenal fatigue actually exists. The public education arm of the Endocrine Society, representing 14,000 endocrinologists, recently issued the following advisory:

“Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.

Unequivocal words. But facts about adrenal fatigue neatly illustrate why a science-based approach is a consumer’s best protection against being diagnosed with a fake disease.

The adrenals are a pair of glands that sit on the kidneys and produce several hormones, including the stress hormones epinephrine and norepiniephrine that are associated with the “fight or flight” response.  Can you tire these glands out? In the absence of any scientific evidence, chiropractor and naturopath James Wilson coined the term “adrenal fatigue” in his 1998 book of the same name. Take a look at the James’ own questionnaire, at adrenalfatigue.org, to see if you have have it. Do you ever experience the following?

  1. Tired for no reason?
  2. Having trouble getting up in the morning?
  3. Need coffee, cola, salty or sweet snacks to keep going?
  4. Feeling run down and stressed?
  5. Crave salty or sweet snacks?
  6. Struggling to keep up with life’s daily demands?
  7. Can’t bounce back from stress or illness?
  8. Not having fun anymore?
  9. Decreased sex drive?

If you answered yes to any of these questions, you may have adrenal fatigue.

Some lifestyles are apparently more vulnerable to adrenal fatigue, including single parents, shift workers, an “unhappily married person”, and the “person who is all work, no play.” There’s no information provided to substantiate the quiz, qualify the vague terminology, or link to any relevant literature. (Of course there is the usual Quack Miranda warning which makes all of this possible: “These statements have not been evaluated by the Food & Drug Administration … etc.”)

Based on this quiz, it’s safe to assume that adrenal fatigue is the most prevalent fake disease in the world. And sure enough, that’s what its proponents think, too:

Dr. John Tinterra, a medical doctor who specialized in low adrenal function, said in 1969 that he estimated that approximately 16% of the public could be classified as severe, but that if all indications of low cortisol were included, the percentage would be more like 66%. This was before the extreme stress of 21st century living, 9/11, and the severe economic recession we are experiencing.

So let’s look into the medical literature on adrenal fatigue. There’s no entry in Dorland’s medical dictionary, nor does the ICD classify it as a medical condition. Pubmed lists only one relevant paper which is a review by two naturopaths, and published in the Alternative Medicine Review. But there’s no evidence for them to review.

Fake diseases are compilations of various symptoms into conditions without any scientific basis. Peter Lipson has examined this in detail here at SBM. As Dr. Lipson points out, it’s human nature to want answers and to understand patterns of symptoms. Defining a cluster of symptoms in general terms is the first mistake. Symptoms need to be collated in a rational way to understand the parameters of the disorder. With adrenal fatigue, there’s no objective operational description, nor is there a validated symptom score. Using a vague list of symptoms to identify patients is the second mistake. While laboratory tests are advertised for identifying adrenal fatigue, there’s no persuasive data to demonstrate that blood or saliva tests provide any meaningful information, or are correlated with any underlying pathology.

Adrenal fatigue shouldn’t be confused with adrenal insufficiency, a legitimate medical condition that can be diagnosed with laboratory tests and has a defined symptomatology. Addison’s disease causes primary adrenal insufficiency and usually has an autoimmune cause, with symptoms appearing when most of the adrenal cortex has been destroyed. Secondary adrenal insufficiency is cause by pituitary disorder that gives insufficient hormonal stimulation to the adrenals. Some liken adrenal fatigue to a milder form of adrenal insufficiency — but there’s no underlying pathology that has been associated with adrenal fatigue. That’s actually a common method of disease invention: take a real disease and claim that it exists in a subclinical form, though of course it lacks a single unambiguous sign or symptom. We are supposed to believe that it’s still a serious problem even though it is, by definition, so mild that it is undiagnosable by any physician.

While adrenal fatigue may not exist, the same can’t be said for the treatments. When you’re treating a fake disease, anything goes. Everything from homeopathy to herbal remedies to hydrotherapy, to traditional Chinese medicine and vitamin supplements are advocated for treatment. The endpoints of treatment are as nonspecific as the criteria for diagnosis. Young, conveniently, has his own supplement programs. The Adrenal Fatigue Institute (apparently unrelated to Young) sells a supplement called Cylapril via TV infomercials and online ads. Disappointingly but perhaps not suprisingly, there are a number of health professionals that offer adrenal fatigue services, from labs that will diagnose it with scientific-looking lab reports [PDF], to pharmacies that offer specialty-compounded adrenal fatigue products.

Conclusion

While adrenal fatigue may not exist, this doesn’t mean the symptoms people experience aren’t real. These same symptoms could be caused by true medical conditions such as sleep apnea, adrenal insufficiency, or depression. Accepting a fake disease diagnosis from an unqualified practitioner is arguably worse. Patients don’t receive a science-based evaluation of their symptoms, and they may be sold unnecessary treatments that are probably ineffective and potentially harmful. There’s no question that it would be frustrating to be experiencing fatigue symptoms and then to be told by a health professional that there is nothing medically wrong. But that is arguably better than the distraction of treating a fictitious condition.

Posted in: Science and Medicine

Leave a Comment (42) ↓

42 thoughts on “Fatigued by a Fake Disease

  1. rork says:

    I think I’ve got it.
    Thank goodness for the Google ads at right offering fixes.

  2. Dr Benway says:

    Scott Gavura, I think you’d make more money by filling the shelves of your pharmacy with the latest naturopathic nonsense as well as the more familiar evidence-based over-the-counter products. Customers find novelty and variety pleasing to the eye. And they respond in a positive way to rhetoric touting “options” and “healthcare freedom.”

  3. Angora Rabbit says:

    Thanks, Rork, for pointing that out. As my students would say, OMG. I am horrified at the Google ads to the right of this blog.

    I realize that one needs to pay for a wonderful website, but is the message being undermined by “Adrenal Fatigue MDs: The Most Highly Trained Physicians in Bioidentical Adrenal Hormones” from http://www.bodyLogicMD.com/ “?

    This website is fabulous and you are doing an outstanding job with little/no resources except your donated time. But if this is the price of having a faster website, I would prefer the slower version. If it is financial, let me be the first to offer to send a check to keep these nonsensical ads off what is otherwise an outstanding website and resource.

    Mind, I could also be blind and not have realized this has been happening for awhile…

  4. Dawn says:

    As a woman, I’m SURE I have this. I mean, geez, I can answer “Yes” to almost all of those questions at one time or another.

    Tired for no reason? Yes! (I mean, insomnia isn’t a reason, right? I love perimenopause…)

    Having trouble getting up in the morning? As a night owl, yeah, always have.

    Need coffee, cola, salty or sweet snacks to keep going? Salty snacks always! Coffee only in the am. Sweet when desired. No cola. Oh, well…is 3 out of 4 OK?

    Feeling run down and stressed? Sure. Why not? Sounds good.

    Crave salty or sweet snacks? See above. I always crave salty snacks. Family failing.

    Struggling to keep up with life’s daily demands? Huh? Like what?

    Can’t bounce back from stress or illness? Depends on the day.

    Not having fun anymore? Depends on what I’m doing.

    Decreased sex drive? Depends on my mood.

    I think I need to find a computer that lets me see the great ads and go buy me some Bioidentical Hormones (adsense at work and home…).

    @Angora Rabbit: the Google ads are based on words in the posting, not selected by the bloggers. They have tried to block them in the past, and usually do protest against really bad ones when made aware of them. They have been there for a long time, but you, probably like me, ignore them normally.

  5. Recovering Cam User says:

    I appreciate this post, as adrenal fatigue is a very popular diagnosis where I live. The primary “diagnostic” tool is a 4x per day saliva test that compares these results to a narrowed scale of “normal” i.e. – if the regular range for the first draw of fasting AM cortisol is 4.5-22.7, these tests argue that the low end of that range should be closer to 13, and anything below that is evidence that the adrenals are starting to have trouble functioning and need support, either via supplements or actual hydrocortisone.

    At the time I discovered I fit this profile, I wasn’t swayed by the argument that the saliva tests were controversial because my plasma results were identical to my saliva results. So I went on HC prescribed by an internist and experienced minor improvement, but it didn’t last, so I ultimately weaned myself off of it with the help of an endo.

    Based on my own experience, I no longer accept the validity of adrenal fatigue, especially since I now know I fit the larger definition of a CFIDS patient, and if my adrenals were the problem, I should have felt dramatically better on HC.

    That aside, I’ve still yet to hear a satisfactory explanation countering the argument that the main problem with adrenal lab tests is that the conventional lab range for adrenal function is too inflexible to account for a slow degradation of the adrenals over time. As a CFIDS patient, I am aware that autopsies of my fellow patients have shown smaller than average adrenal glands with lower than average cortisol output. My endo dismissed this research because, while lower than average, the numbers still fall in the normal range. But I’d still like someone to explain to me the evidence behind the rational that that doesn’t matter, since it doesn’t make sense to me that you can have an AM cortisol reading of 7 with symptoms of fatigue and still be declared normal while a reading of 5.9 will get you diagnosed with Addison’s disease.

    I can imagine its because there’s evidence that enough people function perfectly fine with lowish AM cortisol there’s no reliable correlation, but as I’ve never seen this adequately explained, I’d appreciate hearing your perspective. I know half a dozen people currently undergoing treatment for adrenal fatigue as we speak, and “there’s no evidence adrenal fatigue exists” is too vague to counter the elaborate explanations they’ve been given by the practitioners who are treating them.

    Thanks.

  6. “I realize that one needs to pay for a wonderful website, but is the message being undermined by “Adrenal Fatigue MDs: The Most Highly Trained Physicians in Bioidentical Adrenal Hormones” from http://www.bodyLogicMD.com/ “?”

    I don’t think that I would have noticed the adds if someone hadn’t pointed them out, but given the proclivity for Google to use adds targeted to content, might I recommend a change of the disclaimer “The advertisements below do not necessarily reflect the views of this blog, its authors, or host.”

    to something like…

    “The following advertisements are great examples of the kind of CAM this blog and it’s authors abhor.” Maybe a nice little skull and cross bones icon would be nice*.

    You’d probably be right more often than not.

    *or does anyone remember Mr. Yuck. I loved him.

  7. First my quote was from Angora Rabbit. Second, “nice” twice in a sentence? Yuck, my apologies.

  8. Google’s AdSense ads are an interesting and perpetual problem for any website publishing critical content: you end up with advertising that pushes exactly what you’ve criticized.

    18 months ago I evicted Google’s advertising from my site. I was getting really tired of being contradicted by own advertising! Chiropractic ads next to chiropractic criticism, ew!

    I was earning about $1K/year from the ads, and it hurt a fair bit to give that up. But you know what? I’m waaaaay happier without the ads. I think (hope) that it has made SaveYourself.ca much more pleasant appealing to my target market.

    But mostly I just feel so much … cleaner.

  9. Scott Gavura, I’d be inclined to throw thyroid disease in with the other disorders that can cause some of these symptoms. But I understand that thyroid disease has it’s own subset of diagnostic issues.

    Dawn – when I read the “symptoms” I thought the same thing. Yup, that’s me (sometimes) . Then I thought, ‘welcome to having younger children’. The thing is, what they seem to think of as lifestyle risk factors: shift workers, single parents, unhappily married people, I would just think of as the causes of fatigue, poor sleep, food cravings, poor sex drive, etc.

  10. Th1Th2 says:

    Just affix the word ‘syndrome’ to it and it will be recognized as a disease. If they are still clueless, tag it as ‘idiopathic’. These are just some ways on how Modern Medicine invents a disease category for the faithfuls.

    1. Harriet Hall says:

      Th1Th2 continues to entertain us. Ha, ha, ha! ROTFL.

  11. dedicated lurker says:

    Dawn – I never crave salty stuff, but I can cover the sweets and cola for you. (Vanilla coke is as addictive as crack. And I of course mean in the metaphorical sense.)

  12. Th1Th2 says:

    Make that Adrenal Fatigue Syndrome, no? Adrenal Fatigue Disorder? Adrenal Fatigue-like Syndrome? Adrenal Fatigue-like Disorder? Adrenal Fatigue Spectrum Disorder? Chronic Adrenal Fatigue Syndrome ala CFS? Did I miss something?

    Whatever, just take this miracle drug sheeple!

  13. Adrenal Exhaustion, and all its synonyms, is also a popular explanation for any unexplained symptoms in my veterinary patients as well. There’s an RN out there promoting it as an explanation for Sudden Acquired Retinal Degeneration (SARD).

    http://www.petcarebooks.com/pdf/SARDS_08.pdf

    SARD is, of course, a disease without a clearly defined etiology, so this person has concoted a hypothesis, taken a few random clinical laboratory values and done some statistics to them to make them look “sciency” and set herself up as the expert on this disease most veterinarians are woefully ignorant of.

    Try explaining to a client with a dog who has suddenly gone blind that this apparent source of insight and hope is just made up out of whole cloth and that running these tests and giving these inappropriate horomone supplements isn’t going to bring back the dog’s vision. If they believe you, they are heartborken, and if they don’t they are furious and go looking for a vet who will do what they want whether it makes any sense or not.

  14. jpmd says:

    Perhaps someone could inform me as to how the ads work. If the website gets paid by the hits on the ad, wouldn’t it be a good thing for all of us to click the ads a few times whenever we visit? Might also pull a little money out of the pockets of the snake oil salesmen.

  15. mikerattlesnake says:

    It’s funny when folks who use the word “sheeple” think it makes them look like the informed one in a discussion. Everyone else uses that word sarcastically to mock dumb conspiracy theorists.

  16. Chris says:

    Especially when it is clear the the person using the term “sheeple” seems to think that real medicine made up the condition, showing that it did not read the article.

    Above it states that the one promoting “adrenal fatigue” is:

    In the absence of any scientific evidence, chiropractor and naturopath James Wilson coined the term “adrenal fatigue” in his 1998 book of the same name.

    Plus, the actual doctors, “public education arm of the Endocrine Society, representing 14,000 endocrinologists” are quoted as saying:

    “Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.

  17. Dawn says:

    @dedicated lurker: deal. The only pops (soda) I crave at any time is Vernor’s Ginger Ale and Squirt (Cranberry Red? been so long since I’ve seen it, I forget), and part of that is that they are nearly impossible to find east of the Appalachian mountains so I have my parents bring what they can when they come visit, or I buy and hoard on my trips home.

    Hot Vernor’s on a cold day….YUMMY.

    As usual, Th1Th2 shows their idiocy. And this time proves they don’t read the post.

    Uh, Th1, the REAL doctors say the problem doesn’t exist and you don’t need medication. The QUACK doctors are pushing the supplements.

  18. Th1Th2 says:

    If only Modern Medicine originated the term Adrenal Fatigue Syndrome, it could have been a different story and sheeple would have embraced it in a heart beat.

    Adrenal fatigue syndrome is much more believable than another idiotic I mean idiopathic CFS, at least a target organ is involved.

  19. mark says:

    Off topic: does anyone know where I can get a ‘comments blocker’? I’d hope that I could put in the name of a commenter (eg Th1Th2)and then all comments made by, or related to, that person would disappear. It would make the site much more enjoyable.

    Back on topic: a small group of doctors where I live embraced this diagnosis, and started ordering huge numbers of 24hr urine free cortisol measurements. It took a lot of time to measure them, and costs were substantial. (Especially when the other tests ordered at the same time were factored in- eg serum copper, manganese, silicon, vitamin D etc etc. Often the same battery of tests was requested on the same patient a few months later). An attempt to educate the doctors about the appropriate use of these tests failed, so we ended up restricting them to hospital specialists only.

    I’m not sure how these doctors now confirm their inappropriate diagnoses. Perhaps with more inappropriate tests from other labs where people have to pay for the results.

  20. windriven says:

    @mark

    Chris has it right: ignore Th1Th2. Unlike jock itch there’s no magic cream to make it go away. It feeds on attention. Deny it attention and it will seek it elsewhere.

  21. windriven says:

    @jpmd
    Genius! I’ll make it a point to clicking through to every sCAM ad I see on SBM. We’ll move a little extra $ to help pay for the new server and we’ll do it by skimming a little of the sCAMsters’ profits!

  22. mark says:

    @windriven

    Thanks- I do ignore the comments. But you still have to look at the name to ignore it. It would be much more enjoyable if I didn’t have to see the comments and the way they derail the threads as others respond.

  23. Th1Th2 says:

    mark,

    What are you hanging on to? Those tests are also standard testing to rule out adrenal insufficiency.

    That’s what Modern Medicine do most of the time. Doctors order a lot of tests to satisfy their ego despite a high degree of ignorance to a certain disease.

    Wilson shouldn’t have used the word ‘syndrome’ in the first place. It’s something holy for the Church of Modern Medicine. Only the church can use it. And now he’s being criticized for blasphemy and sacrilege.

  24. Robin says:

    @th1th2, Addison’s disease isn’t “ruled out” using salivary cortisol tests and vitamin panel.

    Usually, when it’s suspected an 8am serum cortisol test will be ordered. If this is low, the patient will be given an ACTH stimulation test. Since ACTH (from the pituitary) stimulates cortisol (from the adrenals), the patient is given simulated ACTH to “test” how well the adrenals produce cortisol. A second time lapse style test is given to differentiate whether the problem is originating in the pituitary or adrenals. Finally, other tests such as imaging and other bloodwork will be performed to identify the cause.

    That is, if a person isn’t in a full blown crisis and in the ER — I think they do a serum cortisol in that case.

    I don’t think the doctor’s in mark’s example should have been restricted from testing stuff like vitamin D which is low in a lot of people, but, they certainly didn’t lose the ability screen for Addison’s w/ the 8am cortisol. (The other testing is done by an endocrinologist.) if they’re looking for adrenal “fatigue” with salivary cortisol they probably shouldn’t be practicing medicine in the first place.

  25. mark says:

    @ Robin

    I oversimplified about the vitamin D test. These doctors could continue to request vitamin D measurements but not repeatedly or in people already on supplements. Restrictions were placed upon tests such as zinc, copper, selenium, mercury, iodine, manganese, IGF-1, IGFBP3, CoQ10, apoE genotyping, salivary cortisol, dihydrotestosterone, and estrone.

    @ Windriven
    It is hard to ignore someone when they make a specific, blantly false statement directed at you. I’m sure the statement was made to provoke a response, but silence seems to imply agreement. That’s why I’d like a comment blocker.

  26. Th1Th2 says:

    Robin,

    “Addison’s disease isn’t “ruled out” using salivary cortisol tests and vitamin panel. ”

    Well, I did say it’s standard test whether the sample taken is serum , urine or saliva.

    The vitamin panel is just to determine other cause of exogenous adrenal insufficiency.

    “Usually, when it’s suspected an 8am serum cortisol test will be ordered. If this is low, the patient will be given an ACTH stimulation test. Since ACTH (from the pituitary) stimulates cortisol (from the adrenals), the patient is given simulated ACTH to “test” how well the adrenals produce cortisol. A second time lapse style test is given to differentiate whether the problem is originating in the pituitary or adrenals. Finally, other tests such as imaging and other bloodwork will be performed to identify the cause.”

    Agreed.

    “if they’re looking for adrenal “fatigue” with salivary cortisol they probably shouldn’t be practicing medicine in the first place.”

    Salivary cortisol: a better measure of adrenal cortical function than serum cortisol.
    These data, combined with a simple, stress-free, non-invasive collection procedure, lead us to suggest that salivary cortisol is a more appropriate measure for the clinical assessment of adrenocortical function than is serum cortisol.

    http://www.ncbi.nlm.nih.gov/pubmed/6316831

  27. Th1Th2 says:

    Robin,

    “That is, if a person isn’t in a full blown crisis and in the ER — I think they do a serum cortisol in that case.”

    Not realistic in ER. It is not considered an urgent test or a priority. ER intervenes based on the signs and symptoms presented by the patient regardless.

  28. windriven says:

    @mark

    It is a dilemma isn’t it. I find myself responding to it sometimes despite my better judgment. The problem is that when you respond with a powerful and well-reasoned argument, you find that it is aimed at … nothing. Like trying to punch a sheet blowing in the wind, there is simply nothing substantial with which to connect.

    That, in part, is why I believe Thing to be a true troll. There is no attempt to engage, only to bait. Reminds me of a little boy poking a stick at a lion through the bars of a cage. Very courageous when there is nothing on the line but loud noises. But without the bars of anonymity me thinks the Thing would dissolve in a puddle of its own urine.

  29. Chris says:

    windriven and mark, you now understand why I post its earlier behavior and try to encourage you to ignore it (though I admit its idiocy sometimes invokes a response… I mean who knows of toddler that stays on the sidewalk!?).

  30. Samantha says:

    @mark

    If you use Firefox, there’s a comment blocker that blocks -all- comments… Dunno if it’s configurable to single users, though. If not, there should be.

    http://www.ghacks.net/2010/08/22/comment-blocker-block-comments-in-firefox/

  31. AlexisT says:

    As someone mentioned, hypothyroidism can have many of the same general symptoms (fatigue in particular). Of course, hypo is overhyped–magazine articles blaming it for everything and telling women to get tested. Thyroid woo would actually be a good subject for SBM. I have mild hypothyroidism and I’ve heard so much weird crap.

  32. Dawn says:

    I’ll have to check at home (usually read SBM at work where my only access is througjh – shudder – IE6), but if Firefox and greasemonkey can block on FF I’ll let you know. I love greasemonkey; I’ve blocked a lot of idiotic trolls that way.

  33. Dawn says:

    Oh…I should have specified….greasemonkey blocks names, but it is specific, so if Th1Th2 morphs, you have to block each morph like a troll called STY (I won’t spell out the name…kinda like calling Beetlejuice 3 times…) from some other blogs.

  34. takoyaki says:

    I have a naturwoopath friend who keeps telling me I have adrenal fatigue and hydrocortisone would help me so much.

    She’s also quite fond of l-methylfolate, and tells me that would help immensely with my bipolar disorder. Research tells me otherwise.

    Disclaimer: We’ve been friends for many years, much longer than she’s been a naturwoopath.

  35. criticalist says:

    Just a few points about the diagnosis of adrenal insufficiency. In the ER if a patient presents with a suspected adrenal crisis, then a serum cortisol would the diagnostic test of choice; if below 100 nmol/l it is confirmatory. However, the test does not come back immediately, so the blood sample would be drawn and the patient started immediately upon steroid replacement treating while awaiting the result.

    Salivary testing does have some basis, as it reflects free cortisol levels, but it is mostly used in research work, not as a part of routine diagnostic investigation. The same for urinary cortisol levels.

    There is an explanation for this comment that someone made

    “But I’d still like someone to explain to me the evidence behind the rational that that doesn’t matter, since it doesn’t make sense to me that you can have an AM cortisol reading of 7 with symptoms of fatigue and still be declared normal while a reading of 5.9 will get you diagnosed with Addison’s disease.”

    The answer is that there can indeed be some overlap and single readings like this can be misleading. If there is a clinical concern then the next step in testing the adrenal axis is dynamic tests; the ACTH stimulation test or the Insulin Tolerance Test are the main ones. Correlation with clinical findings and the response to a trial of treatment are also important.

  36. Recovering Cam User says:

    Thanks for the response, Criticalist.

    The primary issue I see in this area is that people who are diagnosing adrenal fatigue are claiming that there is a middle stage, something between normal functioning and full blown Addison’s, that is being ignored the conventional medical community. Plasma AM cortisol in the lower third of the normal range is considered evidence of this, as are ACTH stim test results in which the cortisol level failed to double even if the final stimmed number was over 18.

    When a patient is feeling awful and a practitioner points to these labs and says, this shows you have adrenal fatigue, it’s going to seem reasonable to a patient hungry for an answer, because its simplistic and easily understandable to hear your numbers are low and that’s why you feel bad.

    How does one counter this argument? What is the evidence that normal ranges really do reflect normal function and these alternative lab interpretations are not valid? I heard one doc say they had looked for evidence of adrenal fatigue and didn’t find it, but what did they look at?

    As I said before, I no longer accept adrenal fatigue as a valid diagnosis because I tried HC and it made only a slight temporary improvement. But the half a dozen people I currently know undergoing treatment for adrenal fatigue don’t give much weight to my anecdotal report, nor the blanket statements issued by the Endo society that it’s not real and doesn’t exist.

    This is a community that’s already predisposed to distrusting paternalistic doctors dismissing their symptoms, so if I’m going to change anyone’s mind, I need, good, rational evidence for how the whole adrenal fatigue theory has been demonstrated to be invalid. If anybody can point me to some resources for that, I’d be most appreciative.

  37. criticalist says:

    I don’t think I have any other resources other than what has already been mentioned on this forum. I can point out something though. You mentioned that people point to a lack of doubling of cortisol in an ACTH stimulation test as evidence of “adrenal fatigue”. As you know the ACTH test is interpreted by looking at the peak cortisol value, not the increase in baseline (often called the delta cortisol). The reason for this is that delta cortisol is often decreased in the normal population as shown by these references:

    Speckart PF, Nicoloff JT, Bethune JE: Screening for adrenocortical insufficiency with cosyntropin (synthetic ACTH). Arch Intern Med 1971, 128(5):761-763.

    Stewart PM, Corrie J, Seckl JR, Edwards CR, Padfield PL: A rational approach for assessing the hypothalamo-pituitary-adrenal axis. Lancet 1988, 1(8596):1208-1210.

    Widmer IE, Puder JJ, Konig C, Pargger H, Zerkowski HR, Girard J, Muller B: Cortisol response in relation to the severity of stress and illness. J Clin Endocrinol Metab 2005, 90(8):4579-4586.

    Thus there is good evidence that lack of doubling of cortisol response is not a valid assessment of the test.

  38. Dawn says:

    Just to say I checked Firefox/greasemonkey at home and for some reason, on SBM you don’t get the option to kill or block comments. I don’t know if it has to do with wordpress, or what. So, sadly, I can’t block Th1Th2′s comments by computer, I’ll just have to ignore them unless they become too stupid to ignore.

  39. Recovering Cam User says:

    Thanks, Criticalist – I appreciate the references.

  40. Bogeymama says:

    Just ran into a friend of mine (at the lab) – she is very well-educated, has a Masters in Education. She told me “they” think she has adrenal fatigue. I didn’t ask who “they” were, but our town is filled with woo-peddlers. She said she’s been reading the internet and she can check all the boxes, so it explains alot. She recently took a leave of absence from work due to stress.

    I said nothing, just “Hmm mmm” when she said it. She is NOT someone who I could sway at all.

Comments are closed.