Adrenal Fatigue is a disorder of low energy and motivation that is suspected to arise from either chronic emotional stress or as the result of living with a chronic disabling medical condition or infection such as Lyme disease. In its worst expression it results in Addison’s disease, a complete, or near complete inability of the adrenal gland to secrete the glucocorticoid hormone know as cortisol. In the absence of cortisol it feels impossible even to get out of bed or take a shower without feeling absolutely exhausted for the remainder of the day. It is a vital hormone to our normal day to day functioning and is needed for optimal functioning.
Adrenal fatigue has been proposed for a number of years as part of the cause of Fibromyalgia. It is difficult to say how it rates in the order of importance as an underlying cause because it also develops as a concurrent problem due to many chronic illnesses such as Lyme and now Long COVID. By the time any patient is diagnosed or discovers through their own research that they may have adrenal fatigue, they have frequently been diagnosed with related disorders such as Fibromyalgia, Chronic Lyme, or depression.
Chronic or lingering stress strains the adrenal gland and central nervous system(CNS) leading to a slow depletion of cortisol, and the catecholamines, epinephrine and norepinephrine. Many of the underlying causes for adrenal or chronic fatigue syndrome are hidden, untestable viral, parasitic, bacterial, and fungal infections. As already stated, adrenal fatigue is often the result of chronic stress or lack of recovery from normal stress. Under normal conditions the body increases excretion of norepinephrine and epinephrine (same as adrenaline), and cortisol when we are under stress. Normal levels of these neurotransmitters and hormones help us feel like we are able to handle the stress without becoming overwhelmed or exhausted. But living with a chronic undiagnosed and thus untreated infection or toxic exposure such as mold, will lead to an initial over secretion of stress hormones and neurotransmitters and then a complete drain or exhaustion of the those resources, leading to a feeling, if not reality, of complete exhaustion. Low levels result in fatigue and of feeling of being too easily overwhelmed by what used to be normal or average stressors. Human beings are designed to have both the physical and mental coping ability to deal with and recover from stress as long as we do it within a small period of time. If emotional stress is persisting or we develop a chronic health disorder and it extends beyond 3 months we risk developing a chronic stress disorder and we will eventually “burnout.” Other symptoms that may coexist with stress is poor sleep quality or restful sleep.
Lab testing is required here to determine the presence and extent of the adrenal fatigue. Many types of testing exist from straight measurement of cortisol, DHEA, and adrenaline in differing sources including urine, saliva, and blood or serum. Cortisol is frequently measured in saliva throughout the day in order to assess the baseline and circadian rhythm. Cortisol should be highest in the morning at rising and in the first few hours of the day. It follows a bell shape curve and reduces toward a steady baseline in the late afternoon and through the night. A flat or low bell curve indicates adrenal fatigue. Typically 4 saliva samples at varying times of the day help to extrapolate the curve. Samples are taken at 8am, 12 noon, 4pm, and 10pm for example.
This same curve or rhythm can be assessed using blood or serum samples throughout the day or simply as a single sample in the morning. If the curve or single sample of cortisol is low, adrenal fatigue may be present. If a morning cortisol sample is elevated it can indicate the early stages of stress. Early interventions can reverse the disorder or progression to complete “adrenal burnout.”
Low DHEA-sulfate in saliva, urine and blood tests will also indicate possible adrenal fatigue. Although low DHEA-s can also be an indicator for hormone imbalance or deficiency. The other extremely valuable test is a serum catecholamine test measuring norepinephrine, epinephrine(adrenaline), and dopamine. Low norepinephrine and epinephrine are indicators for adrenal fatigue. These central and peripheral neurotransmitters are also found present in many other health concerns such as sleep disorders, depression, dysthymia, and inability in managing stress. When treated correctly, adrenal function can return to normal very quickly. Best outcomes occur when both the catecholamines and cortisol are assessed. Treatment to restore adrenals includes targeted amino acid therapy and herbs with specific actions which increase output of norepinephrine, epinephrine, and cortisol.