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Adrenal fatigue

Adrenal fatigue is not yet a recognised medical condition - that means it does not appear in the International Classification of Diseases (ICD). It is a term that may be used when it seems your adrenal glands are not able to cope normally when you are under stress. This may cause you to feel very tired.

Your adrenal glands play a very important role in helping your body respond to physical or psychological stress. It may be that adrenal fatigue is not a medical condition but a description of how you may feel when you are very stressed. There is no evidence that people with adrenal fatigue have anything wrong with their adrenal glands.

There are no specific investigations or treatment for adrenal fatigue. However, a healthy diet, regular exercise and a good sleep pattern can make you feel much better. Adrenal fatigue gets better quite quickly in most people but can sometimes persist for a long time.

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What is adrenal fatigue?

Adrenal fatigue is a term that is sometimes used when tiredness and other symptoms are thought to be caused by your adrenal glands being unable to work normally when you are under stress. It is not a recognised medical condition.

Adrenal fatigue is most often associated with severe or prolonged stress. However, it can also occur during or after any infection, including influenza or any flu-like illness.

For further information about the adrenal glands, see the separate leaflet called Addison's Disease.

What are the adrenal glands and what do they do?

You have two small adrenal glands that lie just above each kidney. Each adrenal gland has an outer part (adrenal cortex) and an inner part (adrenal medulla). Cells in the adrenal glands make various hormones. A hormone is a chemical which is made in one part of the body but passes into the bloodstream and has effects on other parts of the body.

Pituitary and adrenal glands

pituitary and adrenals

Cells in the outer part of the adrenal glands (adrenal cortex) make the hormones cortisol and aldosterone. The amount of cortisol that is made is controlled by another hormone called adrenocorticotropic hormone (ACTH). ACTH is made in a small gland that lies just under the brain (the pituitary gland). This in turn is stimulated by another hormone which is produced by another part of the brain called the hypothalamus. ACTH passes into the bloodstream, is carried to the adrenal glands and stimulates the adrenal glands to make cortisol.

  • Cortisol is a hormone that is vital for health. It has many functions which include:

    • Helping to regulate blood pressure.

    • Helping to regulate the immune system.

    • Helping to balance the effect of insulin in regulating the blood sugar level.

    • Helping the body to respond to stress.

  • Aldosterone helps to regulate salts in the blood and helps to control blood pressure.

Cells in the inner part of the adrenal glands (adrenal medulla) make the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine). These have various actions throughout the body.

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How common is adrenal fatigue?

As adrenal fatigue is not a recognised medical condition, it is not possible to know how many people are affected. However, many people feel very tired during stressful situations and it may well be that adrenal fatigue is quite common.

What causes adrenal fatigue?

Adrenal fatigue is caused when your adrenal glands cannot cope when you are very stressed. The adrenal glands are an essential part of your body's responses to any kind of physical, emotional or psychological stress. During adrenal fatigue your adrenal glands can respond but not well enough to stop you feeling very tired.

Many different types of stress can cause adrenal fatigue. Examples of physical stress include any severe or recurrent infection or illness, having an operation, poor diet or a severe injury. Emotional or psychological stress may be caused by many situations, including relationship, family or work difficulties.

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Who develops adrenal fatigue?

Adrenal fatigue can affect anyone. People vary a great deal in how they can deal with stress. How you respond to stress may also be less effective because of other factors. These factors include poor diet, poor sleep patterns, erratic lifestyle and long-term illness.

What are the symptoms of adrenal fatigue?

The main symptom is severe tiredness (fatigue) that is not relieved by sleep. There may be no obvious symptoms or signs of illness but you may feel generally tired and unwell. You may also find it difficult at times to think clearly. It may feel as though you are unable to function properly and complete tasks. The symptoms may be mild, moderate or severe.

Tiredness associated with adrenal fatigue may feel worse in the early morning and mid-afternoon. You may find it difficult getting up each morning, even after a good night's sleep. You may feel more awake and energetic in the evenings than during the rest of the day. However, people with severe adrenal fatigue tend to feel very tired all the time.

Adrenal fatigue may also reduce your body's ability to fight infections. This may make it more likely to develop common infections such as a sore throat or cold. It may also mean it takes longer to recover from any infection.

You may also have a craving for salty or sweet drinks or foods. You may feel you need to drink coffee or other stimulant drinks very frequently to help you feel more awake and alert.

It is also believed that adrenal fatigue may cause other symptoms. These may include dizziness, low sex drive and weight gain.

How is adrenal fatigue diagnosed?

There is no test which can tell whether or not you have adrenal fatigue. A 24-hour salivary adrenal test has been used to check the function of the adrenal glands. However, many doctors, including adrenal gland specialists, do not consider that this test is appropriate to measure the function of the adrenal glands.

A 24-hour salivary adrenal test involves taking saliva samples four times during 24 hours. The samples are usually taken at 8 am, 12 noon, 4 pm and midnight. The early-morning steroid (cortisol) level should be the highest level of the day but may be reduced if the adrenal gland is not working properly.

You may need blood tests to make sure there are no other reasons why you feel very tired, such as anaemia or an underactive thyroid gland. Further tests will also be needed if there is any concern that your adrenal glands are not working properly.

What is the treatment for adrenal fatigue?

The treatment for adrenal fatigue is essentially lifestyle advice, including sleep, diet and exercise. Talk with your doctor to discuss how you are feeling so that your doctor can arrange tests if needed and also provide you with advice and support.

It is very important to reduce stress and improve relaxation. See also the separate leaflets called Acute Stress Reaction and Stress Management and also the leaflet called Relaxation exercises.

Eat plenty of fruit and vegetables. Avoid junk foods and processed foods. Also avoid or reduce coffee and any other stimulant drinks and reduce your intake of sugary drinks and foods. See also the separate leaflet called Healthy Eating.

Regular exercise is also important. See the separate leaflet called Exercise and Physical Activity.

It is very important to have enough sleep and to stick to a consistent sleep routine. For more information see the separate leaflet called Insomnia (Poor Sleep) and the leaflet called Sleep diary.

There is no evidence that supplements (such as vitamin supplements) are of any value, and some supplements may be harmful.

What is the outlook (prognosis)?

Most people with adrenal fatigue will recover quite quickly but severe symptoms may take some months to recover, or even longer. The time for recovery will vary enormously from person to person and will also depend on the cause of stress and the severity of symptoms. Following a good treatment plan, as described above, will help you to recover more quickly.

Further reading and references

  • Cadegiani FA, Kater CE; Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016 Aug 24;16(1):48. doi: 10.1186/s12902-016-0128-4.
  • Ross IL, Jones J, Blockman M; We are tired of 'adrenal fatigue'. S Afr Med J. 2018 Aug 28;108(9):724-725. doi: 10.7196/SAMJ.2018.v108i9.13292.

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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