The term adrenal fatigue suggests that chronic stress wears out the adrenal glands, leading to exhaustion and low cortisol levels. Cortisol, the main stress hormone produced by the adrenal cortex, regulates metabolism, immunity, blood pressure, and attention. It follows a daily rhythm, highest in the morning and lowest at night, controlled by the hypothalamic-pituitary-adrenal (HPA) axis. Proper cortisol balance is essential for stress response, recovery, and overall homeostasis.
Many people experience ongoing tiredness, low mood, cravings, or brain fog and seek answers online. The term adrenal fatigue has gained popularity, but it can be misleading. It often masks other treatable causes such as hypothyroidism, depression, sleep apnoea, or true adrenal insufficiency. Misdiagnosis can delay proper evaluation and treatment.
What Happens in Adrenal Fatigue: Supporters of this concept claim that long-term stress depletes cortisol production. However, scientific studies have shown no consistent differences in cortisol or ACTH levels between people with fatigue symptoms and healthy individuals. While minor variations exist in small studies, most evidence does not support the idea that the adrenal glands burn out.
Signs of Adrenal Fatigue and Cortisol Dysfunction: Commonly reported symptoms include constant fatigue, difficulty waking up, salt or sugar cravings, daytime energy slumps, and poor stress tolerance. These signs are non-specific and overlap with many other conditions, including thyroid disorders, anxiety, depression, and chronic fatigue syndrome.
Is Adrenal Fatigue Real? No, adrenal fatigue is not real. A systematic review found no scientific basis for adrenal fatigue, as cortisol levels and adrenal responses are not consistently abnormal. Only clinically validated conditions, such as adrenal insufficiency, meet diagnostic standards. While the symptoms are genuine, the label adrenal fatigue misinterprets their cause.
How Can These Signs Be Investigated? If someone presents with chronic fatigue, a doctor will take a detailed history, perform an examination, and order appropriate tests. These may include thyroid function (TSH, free T4), full blood count, blood glucose, sleep studies, mental health assessment, and when it is indicated, adrenal function tests like morning cortisol or an ACTH stimulation test. These help rule out true endocrine disorders but are not used to diagnose adrenal fatigue.
Treatment Options: Since adrenal fatigue is not a recognised medical diagnosis, treatment should target the actual underlying cause. For example, antidepressants or cognitive behavioural therapy for depression, CPAP for sleep apnoea, or thyroid replacement for hypothyroidism. True adrenal insufficiency requires a prescribed replacement under medical supervision.
Supporting Healthy Cortisol Levels: Rather than trying to boost cortisol, the goal should be to support its natural rhythm. Key strategies include:
- Maintaining regular sleep and wake times
- Managing stress through mindfulness or relaxation techniques
- Staying physically active
- Eating a balanced diet
- Avoiding excessive caffeine or stimulant use.
Consequences if Left Untreated: Ignoring persistent fatigue may allow serious underlying issues, such as hypothyroidism, Addison’s disease, anaemia, or depression, to progress. Mislabelling symptoms as adrenal fatigue can delay proper care and lead t o unnecessary or unsafe supplement use.
Conclusion: Adrenal fatigue is a medical myth. True cortisol disorders, like adrenal insufficiency, are rare but diagnosable. Investigating fatigue properly and addressing the real cause is essential. Supporting cortisol health through balanced lifestyle choices remains the safest and most effective approach. If you experience ongoing tiredness or stress, seek professional medical advice.
