Adrenal fatigue is a mild form of adrenal disease, which is not generally considered a medical diagnosis. It is a functional assessment of the adrenal organ system, and is often used by naturopathic medical doctors. Symptoms of adrenal fatigue include weakness, fatigue, and orthostatic hypotension.
The adrenal cortex has three layers; the outer layer (zona glomerulosa) is the site of mineralcorticoid production, the inner two layers (zonae fasciculata and reticularis) are the site of glucocorticoid and androgenic hormone production.
Cortisol (hydrocortsone) is the main glucocorticoid hormone produced by the adrenal cortex. The overall effect of cortisol is one of stress adaptation. It has a wide range of effects on the metabolism of fats, carbohydrates, proteins, sodium and potassium. Cortisol is under the regulation of ACTH from the pituitary, which in turn is under the regulation of corticotropin-releasing hormone (CRH) from the hypothalmus.
Aldosterone is the principle mineralocorticoid. It is involved in the regulation of water balance through the retention of sodium. Aldosterone is primarily under the control of the renin-angiotensis system and to a minor degree ACTH.
Dehydroepiandrosterone (DHEA) is the main androgen produced by the adrenal cortex.
70% are "idiopathic" (of unknown cause), autoimmune caused atrophy of the adrenal cortex. Other causes include tuberculosis, histoplasmosis and other fungal diseases, carcinoma, amyloidosis, and bilateral adrenal hemorrhage.
Acute illness activates the HPA axis, resulting in increases in ACTH and cortisol, the laboratory workup for Cushing syndrome should not be performed when subjects are acutely ill.
States of Increased HPA Activity: Chronic stress, Melancholic depression, Anorexia nervosa, Obsessive-compulsive disorder, Panic disorder, Excessive exercise, Chronic active alcoholism, Alcohol and nicotine withdrawal, Diabetes mellitus, Central obesity, Sexual abuse, Hyperthyroidism, Premenstrual tension syndrome, Cushing syndrome, Pregnancy
States of Decreased HPA Activity: Adrenal insufficiency, Atypical/seasonal depression, Chronic fatigue syndrome, Fibromyalgia, Hypothyroidism, Nicotine withdrawal, Post glucocorticoid therapy, Post Cushing syndrome, Postpartum period, Post chronic stress, Rheumatoid arthritis
Chemistry screen reveals low sodium, high potassium, and an elevated BUN.
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