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Adrenal Fatigue


The most common adrenal gland dysfunction is adrenal fatigue, a hormone weakness with varying degrees of reduction in the function of the adrenal glands. Ref. 16 deals with this condition in great detail. Here I am only giving an overview of this condition. Our adrenal glands are situated above the kidneys. These hormone glands have a circadian rhythm with the highest amount of adrenal gland hormones being produced in the morning and a gradual decline throughout the day. Our meals (breakfast, lunch and dinner) as well as any snacks lead to mini peaks of the adrenal gland hormone production. If we get enough sleep, there is no excessive stress in our lives and we do not smoke or abuse alcohol and drugs, most people will not know that they have adrenals as they are quietly working in the background.

Adrenal gland failure can develop

However, when allergies develop to a large amount of food components, you catch every flu that goes through the community. Your energy leaves you mid afternoon for the rest of the day. This is a sign that adrenal fatigue is probably setting in. When this is not attended to, a full-blown collapse can occur as a result of adrenal gland failure developing. This is also known as Addison’s disease. It appears that there are several possible causes of adrenal fatigue. Any prolonged stress reaction that results in prolonged ACTH stimulation of the adrenal glands can lead to of adrenal glands exhaustion. Food allergies often also seem to cause or contribute to adrenal gland fatigue. Several severe emotional stresses and/or mental disease will be able to overproduce ACTH production.

Poor lifestyle choices

Junk foods, skipped meals and poor life style choices (drinking habit, drug abuse, smoking, lack of sleep and excessive caffeine intake) will also produce adrenal gland fatigue as this leads to failing hormone production of the adrenal glands. According to Dr. Hertoghe (Ref. 18 and 19) adrenal fatigue and adrenal insufficiency (Addison disease) can be part of a general hormone disbalance. Patients may be found to be hypothyroid as well and perhaps test vary low when IGF-1 (=somatomedin C) is tested. This indicates insufficiency of growth hormone production, which is particularly common after the age of 60. Male and female sex hormones are frequently found to be low as well.

Adrenal Fatigue Symptoms

There are a variety of symptoms that are associated with adrenal gland fatigue. Dr. Wilson has provided a test where you can rate yourself to see whether you likely suffer from this condition (Ref. 16). In the questionnaire such symptoms as dizziness, faintness, excessive drowsiness (particularly after eating) and insomnia are listed. Various symptoms in the ears, nose or throat can be present, for instance a runny or stuffy nose, blurred vision, ringing in the ears, a fullness in the ears and hearing loss, a sore throat, gagging and canker sores; recurrent sinusitis, chronic itching of the roof of the mouth and a chronic cough may also be present. Heart palpitations or an increased heart rate (between 85 to 100 beats per minute resting), chest congestion, frequent hoarseness and asthma can also be symptoms of adrenal fatigue.

Gastrointestinal and skin symptoms

Gastrointestinal symptoms include vomiting, nausea, diarrhea, belching, bloating after meals, passing gas (flatulence), abdominal pains or cramps and feeling full long after having had a meal.

Skin symptoms include hives, itching without any apparent reason, rashes, paleness, dermatitis and eczema. Less specific, general symptoms are common as well: muscle weakness and chronic fatigue, joint aches and pains or muscle aches, and swelling of hands, ankles and feet.

Other symptoms of adrenal fatigue

Other symptoms may affect the urinary/genital area as for instance urinary frequency or urgency, vaginal itchiness or vaginal discharge. Excessive hunger or binge eating can also be a symptom of adrenal fatigue. Psychological symptoms can be anxiety, depression, irritability, lethargy, cravings, aggressive behavior, confusion, restlessness, difficulties to concentrate, learning disabilities, slurred speech, stuttering and others. Even a vague symptom of cloudy thinking or fogginess can be a symptom of adrenal fatigue. You can take the test to determine whether you likely have adrenal gland fatigue and then read more details in Ref. 16.

 Adrenal Fatigue

Adrenal Fatigue

Diagnostic tests

There are clinical tests and hormone tests that can be used to determine whether or not a person is suffering from adrenal fatigue.

  1. Dr. Arroyo described an iris contraction test. Have a friend help you to shine a flash light in your eye. Normally the pupil gets small (iris contracts) and stays contracted because of the normal adrenal gland hormones (Adrenaline and Noradrenalin). With adrenal fatigue this pattern is reversed and the pupil will not stay small despite the light shining in your eye. This abnormal widening of the pupil despite the continuing light stimulus will occur within 2 minutes and only after 30 to 45 seconds will the iris recover and contract again (small pupil).

Postural low blood pressure test

  1. Postural low blood pressure test: Normally when you take the blood pressure in the lying position and then get up, there is an immediate elevation of the blood pressure of 10 to 20 millimeter mercury (mmHg).
    With adrenal fatigue there is a paradoxical lowering of the blood pressure by 10 mmHg or more when standing up (compared to the baseline supine reading).
  2. Sergent’s White Line Test: this test was first detected by a French physician by the name of Emile Sergent. When you take the dull end of a ballpoint pen and lightly stroke the skin on your abdomen, a white line initially is followed be a red mark within a few seconds. In a person with adrenal fatigue the white line stays for approximately 2 minutes and widens. This test is only positive in moderate to severe adrenal fatigue.

Saliva cortisol test

  1. Saliva cortisol tests: Saliva steroid hormone tests are more reliable than blood tests as the hormone receptors will remove the hormones from the blood thus transporting the hormone into the tissue. This is true not only for testosterone, DHEA, estrogens and progesterone, but also for cortisol (the stress hormone). Saliva tests for cortisol have the additional advantage of being able to examine the diurnal variation of cortisol in tissues, which normally follows a curve with the highest level in the morning and a lower level in the evening. It is with this in mind that the most reliable laboratory test for adrenal fatigue is a 4 point saliva test (4 separate vials with saliva) for cortisol. Ref. 17 explains the rationale for doing this test to get a precise clinical picture of how the adrenal function is during the course of the day. A cortisol curve for a patient with adrenal fatigue is flat and well below the normal range for people with normal adrenal function. Physicians who have an interest in anti-aging medicine will be able to work with you regarding this test. Many naturopathic physicians would also be able to help you.

Other tests for adrenal fatigue

  1. Other tests for adrenal fatigue: A 24 hour urine sample is helpful when when the physician wants tests for several hormones. For instance, cortisol, aldosterone and sex hormones can all be analyzed from one urine sample that was collected over 24 hours. An ACTH challenge test combined with measuring 24 hour urine hormones is sometimes useful in more complicated cases, but saliva hormone tests seem to be the new norm for most cases.
  2. As mentioned above, it is wise to test a panel of hormones to not overlook other hormone deficiencies that may be present at the same time.

Treatment of Adrenal Fatigue

Treatment for adrenal fatigue consists of a comprehensive holistic approach. To regain your energy you need to pay attention to changing your lifestyle, watch closely what you eat and drink and pay attention to your thoughts stresses in your life. Getting regular breaks and a good night’s sleep is all part of the therapy in addition to vitamin and mineral supplements. The adrenal glands need a lot of vitamin C to produce the adrenal gland hormones. In addition the patient requires vitamin B complex as well as salts (table salt and magnesium). The patient also requires trace minerals (zinc, manganese, selenium, molybdenum, chromium, copper and iodine) for the adrenal glands to function properly.

Eliminate sugar and refined carbohydrates

You need to eliminate sugar and refined carbohydrates (potatoes, bread, pasta, rice). Replace this with complex carbohydrates (lettuce, vegetables, and fruit) and add to this organic meat (lean chicken, buffalo, beef, lamb and pork). You need three meals a day (do not skip breakfast!) with snacks half-way through the morning and afternoon. You may also have a snack prior to going to sleep at night. In addition you need regular aerobic and anaerobic exercises 3 to 5 times per week. Ballroom dancing, swimming, walking are also acceptable as alternative exercising. You need lots of sleep (more than a non-adrenal fatigue person). Dr. Wilson gives details about supplements on this site where herbs, vitamins and minerals are premixed, so that it is easy to take.

Herbs supporting the adrenal glands

The following herbs are useful in supporting the adrenal glands: Licorice root, Ashwagandha root and leaf, Korean Ginseng root, Siberian Ginseng root, ginger root and Ginkgo biloba leaf.
There are also herbs that are bad for the adrenal glands and need to be avoided: avoid Ephedra (MA HUANG), the cola nut, and strong black teas. As stated earlier, coffee and caffeinated drinks and sodas must be avoided. The only exception is green tea, which has adrenal gland supportive effects so that the small amount of caffeine can be tolerated by most except the ones with the more severe form of adrenal fatigue.

Adrenal gland extracts

To stabilize severe cases of adrenal fatigue it is useful to use adrenal gland extracts. The treating physician may have to add small amounts of bioidentical cortisol (Cortef tablets) in more severe cases. A typical replacement dose of cortisol (=hydrocortisone) is 10 mg tablet of Cortef in the morning to mimic the diurnal variation and 5 mg with lunch and 5 mg with dinner. The patient takes this best together with adrenal gland extract. A physician knowledgeable in treating adrenal fatigue should supervise this treatment closely. At the end there has to be a gradual weaning process from the Cortef over several months. Sometimes this can take up to 2 years in order to avoid shrinking of the adrenal glands.

It is safe to give low dose natural cortisol

At the Anti-Aging Conference in Las Vegas (Ref.19) Dr. Hertoghe pointed out that it is perfectly safe to give low dose natural cortisol in smaller doses.  The dosage would be between 5 mg and up to 15 mg per day on an ongoing basis and there are no untoward side effects. He finds in his patients that growth hormone, thyroid hormone and/or sex hormone deficiencies are present simultaneously. These deficiencies must be treated as well to allow the patient to recover fully.


  1. B. Sears: “The age-free zone”. Regan Books, Harper Collins, 2000.
  2. R.A. Vogel: Clin Cardiol 20(1997): 426-432.
  3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 8: Thyroid disorders.
  4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 7:Pituitary disorders.
  5. J Levron et al.: Fertil Steril 2000 Nov;74(5):925-929.
  6. AJ Patwardhan et. al.: Neurology 2000 Jun 27;54(12):2218-2223.
  7. ME Flett et al.: Br J Surg 1999 Oct;86(10):1280-1283.
  8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 261: Congenital anomalies.
  9. AC Hackney : Curr Pharm Des 2001 Mar;7(4):261-273.
  10. JA Tash et al. : Urology 2000 Oct 1;56(4):669.

More references

  1. D Prandstraller et al.: Pediatr Cardiol 1999 Mar-Apr;20(2):108-112.
  2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
  3. J Bain: Can Fam Physician 2001 Jan;47:91-97.
  4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
  5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
  6. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA
  7. George Gillson, MD, PhD and Tracy Marsden, BScPharm: “You’ve hit menopause, now what?” (3 simple steps to restoring hormone balance); Rocky Mountain Analytical Corp., 2nd edition, 2004, Canada
  1. Thierry Hertoghe, MD with Jules=Jaques Nabet, MD: “The Hormone Solution – Stay younger longer with natural hormone and nutrition therapies.”  2002 Three Rivers Press, New York, USA
  2. 19th Annual World Congress Anti-Aging and Aesthetic Medicine in Las Vegas (December 8-10, 2011)

Last modified: September 10, 2019

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.