The adrenal glands are two small organs that sit above the kidneys.  Their job is to produce stress hormones and androgens.  The most import stress hormone they produce is cortisol.  Cortisol allows the body to handle stress.  Its primary role is increased sugar production for energy and reduction of inflammation. 

The adrenal glands normally produce the most cortisol in the morning around 8am and continue to produce declining amounts of cortisol throughout the rest of the day with the lowest amount in the evening time.  During stressful situations the amount of cortisol production can be markedly increased.  The adrenal glands, however,  cannot sustain a high output of cortisol for prolonged periods of time.  When the human body is under constant stress and the adrenal glands are continually stimulated to produce high levels of cortisol, the adrenal glands eventually become fatigued and the level of cortisol begins to decline. 

The most common symptom that occurs when the adrenal glands are no longer able to keep up with the demands of the body is fatigue.  This is expressed as a lack of energy which occurs primarily in the morning and mid day.  Stimulants such as caffeine are often used to overcome this lack of energy caused by low cortisol production.  However, as the body continues to stay under stress the cortisol levels continue to decline and even caffeine may not be able to sustain energy levels throughout the day.  During the evening when the body is beginning to relax the adrenal glands are actually able to produce more cortisol than  would normally be produced at this time which can cause restless sleep and insomnia.  

This creates a vicious cycle that leads to more adrenal stress and eventually to adrenal fatigue.  This process can take months to occur but the effects can last for years if not treated.  Oddly enough, blood test performed during adrenal fatigue are low but still within the normal range.  This is the primary reason that adrenal fatigue often goes untreated.  Diagnosing adrenal fatigue is most often accomplished by a thorough history and careful evaluation of the patients complaints in comparison to the morning cortisol level and ruling out other causes of fatigue such as chronic infections like Epstein-Barr, sleep disturbances like sleep apnea, thyroid disorders and lack of proper nutrition. 

Adrenal fatigue, fortunately, can be easily treated with normal replacement doses of natural cortisol.  Natural cortisol is most commonly taken first thing in the morning and a second dose between noon and 2pm but more frequent doses may be required.   In some patients a longer acting form may be given called Medrol.   Usual treatment is approximately 6 months but can last longer depending on the severity of symptoms and the presence of continued stress.   We at Human Performance Longevity Center are committed to providing the most up to date management and treatment of adrenal fatigue syndrome.     

Brian K Arcement, M.D. FSCAI
Interventional Vascular Cardiology
Board certified Internal Medicine
Cardiology, Interventional Cardiology
Diplomat American Board of Anti-Aging Medicine