Adrenal Fatigue


The adrenals are a pair of pea-sized glands located atop each kidney. The adrenal gland consists of two sections: the medulla (inner portion) and the cortex (outer portion). The adrenal glands release certain hormones that allow us to be able to deal with immediate and long term stress. These glands and the hormones they release allow us to be resilient to day to day stress. 

Under-active adrenal glands are evident in about two-thirds of CFS patients. The majority of patients I see for chronic illnesses, including are suffering from it. They have literally burned their stress-coping organ out. Amid years of poor sleep, unrelenting fatigue, chronic pain, excessive stimulants, poor diet, and relying on a plethora of prescription medications, the adrenal glands and the hormones they release have been used up. Once adrenal exhaustion sets in, it’s not long before the body begins to break down. Getting “stressed out” and staying “stressed out” is the beginning of chronic illness.


Adrenal fatigue is known to cause:

• hypoglycemia (low blood sugar)
• hypotension(low blood pressure)
• neural mediated hypotension (become dizzy when stand up)
• fatigue
• decreased mental acuity
• low body temperature (a sign of low thyroid function)
• decreased metabolism
• a compromised immune system
• decreased sense of well-being (depression)
• weight loss
• hyperpigmentation (excess skin color changes)
• loss of scalp hair • excess facial or body hair
• vitiligo (changes in skin color)
• auricular calcification (little calcium deposits in the ear lobe)
• GI disturbances
• nausea • vomiting • constipation • abdominal pain
• diarrhea • crave salty foods • muscle or joint pains

The Medulla

In the inner region of each adrenal gland is what’s known as the medulla. The adrenal medulla produces norepinephrine and epinephrine (adrenaline). These hormones are known as catecholamines. The medulla hormones are primarily involved in acute (immediate) responses to stress.


• increases the speed and force of the heart beat.
• increases systolic blood pressure (the top number -120/80)
• increases pulse rate
• increases cardiac (heart ) function
• dilates (opens) the airways to improve breathing
• increases the rate and depth of respiration to allow more oxygen to reach the bloodstream
• mobilizes sugar from the liver to the blood stream in preparation of the fight or flight response
• regulates circulatory, nervous, muscular, and respiratory systems when needed.
• inhibits the muscle tone of the stomach, so you may feel a “knot” in your stomach during times of stress.
Restoring adequate epinephrine levels is important. This can be done with SAMe. However, I’ve found that by restoring the adrenal cortex and its hormones, cortisol and DHEA, adrenal fatigue can be overcome.

The Cortex

The adrenal cortex is primarily associated with response to chronic stress (infections, prolonged exertion, prolonged mental, emotional, chemical, or physical stress). The hormones of the cortex are steroids. The main steroid is cortisol. Chronic over secretion of cortisol leads to adrenal exhaustion, which accelerates the downward spiral towards chronic poor health. Once in adrenal exhaustion your body can’t release enough cortisol to keep up with the daily demands. Eventually you become deficient in cortisol and then DHEA. Chronic headaches, nausea, allergies, nagging injuries, fatigue, dizziness, hypotension, low body temperature, depression, low sex drive, chronic infections, and cold hands and feet are just some of the symptoms that occur with adrenal cortex exhaustion.

Abnormal Circadian Rhythm

Cortisol levels are affected by stress and the body’s circadian rhythm (sleep-wake cycle). Cortisol secretions rise sharply in the morning, peaking at approximately 8 a.m. After its peak, cortisol production starts to taper off until it reaches a low point at 1 a.m. Fluctuations in cortisol levels can occur whenever normal circadian rhythm is altered (a change in sleep-wake times). Traveling through different time zones (jet lag), changes in work shifts, or a change bed time can cause drastically alter normal cortisol patterns. Some patients will report that their symptoms began when they began working at night. Some will begin to have symptoms after staying up several nights in a row to take care of invalid family members or newborn babies. Changes in circadian rhythm can lead to insomnia and poor sleep. An example of this occurs when a person tries to go to sleep at a certain time but can’t wind down. They may catch a second wind when their cortisol levels kick-in. This is why it is important for you to try to go to bed (preferably before 11:00 p.m.) and wake-up at the same time each day. Establishing normal sleep and wake times is crucial in restoring normal circadian rhythms.

Adrenal Burnout

People often experience stress reactions every few minutes when bombarded by stimulus coming from our radios, driving in traffic, cell phones, pagers, and from electromagnetic pollution.

Studies show that chronic noise exposure, for example, can significantly raise cortisol levels. This leads to fatigue and problems with concentration. Persistent, unrelenting stress will ultimately lead to adrenal burnout.

Not Enough DHEA

The adrenal cortex, when healthy, produces adequate levels of dehydroepiandrosterone (DHEA).
DHEA boosts:
• energy • sex drive • resistance to stress • self-defense mechanisms (immune system) • general well-being
DHEA helps to raise:
• cortisol levels • overall adrenal function • mood • cellular energy • mental acuity • muscle strength • stamina
DHEA is notoriously low in FMS and CFS patients. Chronic stress initially causes the adrenals to release extra cortisol. Continuous stress raises cortisol to abnormally high levels. Then the adrenal glands get to where they can’t keep up with the demand for more cortisol. As the cortisol levels continue to become depleted from on going stress the body attempts to counter this by releasing more DHEA. Eventually they can’t produce enough cortisol or DHEA. Aging makes holding on to DHEA even tougher. Even in healthy individuals, DHEA levels begin to drop after the age of 30. By age 70, they are at about 20% of their peak levels.

DHEA helps prevent the destruction of tryptophan (5HTP), which increases the production of serotonin. This helps provide added protection from chronic stress. Studies continue to show low DHEA to be a biological indicator of stress, aging, and age-related diseases including neurosis, depression, peptic ulcer, IBS, and others.
The decrease in DHEA levels correlates with the general decline of cell-mediated immunity and increased incidence of cancer. DHEA protects the thymus gland, a major player in immune function.
These same stimulatory responses that affect the muscles also cause changes in various bodily organs: abnormal heartbeats, peptic ulcers (too much stomach acid), hypertension, spastic colon, and irregular menstrual periods. This is why you can’t separate emotional stress from physical stress. Testing for DHEA levels is recommended. However, I often place my patients on a trial of 25mg (women) or 50mg (men) of DHEA prior to testing.

Self Test Methods

A quick blood pressure test that monitors lying and standing systolic numbers can help us begin a trial treatment of adrenal boosting supplements.

Orthostatic Blood Pressure

Ragland’s sign is an abnormal drop in systolic blood pressure (the top number) when a person arises from a lying to a standing position. There should be a rise of 8

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