Recognising the adrenally fatigued patient

Our ability to cope with stress depends largely on the complex interactions between components of our hypothalamic-pituitary-adrenal axis (HPA axis). The adrenal cortex figures prominently in the manifestation of adrenal fatigue due to disregulation of the production of cortisol. Adrenal fatigue is not widely medically recognised, and lies somewhere between the underactivity of Addison’s disease and the overactivity of Cushing’s Disease, where cortisol levels lie at the extremes.

Stress induced adrenal changes
Adrenal fatigue arises from stressful situations that are cumulative over time, rather than from stresses that are successfully dealt with and balance restored. As recovery and repair are inhibited, an individual may experience damage to various tissues and organs due to hormone and neurotransmitter disregulation, often leading to burnout. (1). One of the best ways to discover if a patient actually has adrenal fatigue is to get them to complete Dr Wilson’s Adrenal Fatigue quiz online (2).

Consequences of adrenal stress
Patients will typically present with exhaustion, craving for salt, decreased sex drive, cognitive impairment, difficulty getting up in the morning, mild depression and a stressful case history. Often the immune system is compromised, initially with increased colds, flu and infections due to higher cortisol and later with the appearance of chronic inflammatory conditions as cortisol drops due to exhaustion of the adrenal cortex. Cortisol resistance may have also set in, characterized by the immune system running out of control with increased cytokine production, allergies, fibromyalgia and increased autoimmune conditions such as rheumatoid arthritis (1).

Adrenal inhibition of the thyroid gland
Frequently, stressed people have both low thyroid and low adrenal activity. This is due to the increased production of CRH (corticotrophin releasing hormone). This inhibits TSH, causing a reduction in thyroid hormone production. However, in this case thyroid replacement may not be helpful, as the body wants to slow down under the influence of stress and higher cortisol levels (3). It is important to recognise the prime cause and treat appropriately.

Tests for adrenal fatigue
A patient with postural hypotension (low blood pressure when suddenly standing) frequently indicates adrenal fatigue. To test, lay the patient down for 10 minutes and then take their blood pressure. Then stand them up and take it again. The pressure should rise by 10-20mmHg. If this does not occur, or if the BP drops (especially by 10mm or more) the patient is suffering from adrenal fatigue (4).
Another quick test is to shine a pen-light (or torch) across one eye of the patient in a darkened room. The pupil should contract immediately in a normal healthy patient. If the pupil contracts initially and then dilates again (in spite of the light) within a minute or two, this indicates adrenal fatigue. The dilation may last for 30-45 seconds before contracting again. The longer the dilation, the more severe the fatigue (4).
Salivary cortisol tests may clarify the situation further.

Natural approaches to treatment
The associated presence of anxiety/panic attacks/depression in a patient is an indication for nutrition supplementation with magnesium, B vitamins and zinc. Mood support herbs may also be useful and include kava, lemon balm, holy basil, St John’s Wort, saffron, rhodiola and mimosa. Adaptogenic supplements should concentrate on withania and/or ginseng. Reishi mushroom (Ganoderma lucidum) can support stamina and the immune system. Restoring a healthy gut may require probiotics and Saccharomyces boulardi. Where there is chronic inflammation associated with adrenal fatigue, omega-3 oils and curcumin are the first choice. To improve sleep, choose from tart cherry, lavendar oil, valerian and ziziphus, together with magnesium and lactium.
Other lifestyle measures may include an improved diet with avoidance of stimulants and sugar. Mindfulness meditation and breathing practices, yoga, adequate hydration, positive self-talk and a conscious enjoyment of the funny side of life are also helpful.
Exercise should be undertaken moderately and not to the point of fatigue. Tai chi and qi gong are beneficial during times of adrenal stress.
(1) www.adrenalfatigue.org
(2) www.adrenalfatigue.org/take-the-adrenal-fatigue-quiz
(3) www.drlam.com/blog/adarenal-fatigue-verses-hypothyroidism-part-1/3643/
(4) www.adrenalfatiguerecovery.com/adrenal-function-tests.html

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