Adrenal fatigue, adrenal burnout, hypoadrenia, adrenal exhaustion, adrenal insufficiency – whatever you want to call it – refers to lowered adrenal function or output. However, it is prudent to address the terminology correctly when referring or discussing cases with other allied care professionals.
Adrenal insufficiency, the term used by the allopathic community, indicates a dysfunction of the adrenal glands most commonly referred to as Addison’s disease. It would be wise to reserve the use of this terminology for that clear diagnosis when discussing with the medical community, who, at this point, has not yet embraced the idea of adrenal fatigue as even existing. This will likely change with time – no different than restless leg syndrome or fibromyalgia that were once considered nonexistent conditions until the drug companies created pharmaceutical treatments for them.
Adrenal glands produce key hormones that prepare our body for stress. They are innervated by the sympathetic branch of the autonomic nervous system. Epinephrine, noepinephrine, cortisol, cortisone, aldosterone, DHEA and other sex hormones including estrogen, progesterone, testosterone and pregnenalone are all secreted by the adrenal glands.
When the body senses a threat and moves into a flight or fight response, both adrenalin and cortisol will elevate blood pressure and increase the release of glucose in the blood, preparing the body for survival.
This is a situation that we are all aware of, or, at least, should be, considering that it affects the majority of the population. Just look at the increase in work hours, pills for insomnia, coffee shops on every corner serving extra large cups of coffee, and technology keeping us dialled in 24/7. Prolonged stress is now the norm versus the exception.
In the early phases, the body responds appropriately with elevated stress hormones. High cortisol output affects blood vessel constriction, elevates heart rate, increases blood sugar, raises blood pressure, reduces gastric motility and digestive juice production, and creates a natural high, the opposite of depression. After a prolonged period of time the adrenals cannot keep up and low cortisol and glucocorticoid output is the result.
Some of the symptoms associated with low output include: fatigue not relieved by a few good night’s sleep; poor circulation; low blood sugar level (hypoglycemia); low blood pressure; allergies; apathy or depression; joint aches and pains, specifically in the lower back and knee; low gastric hydrochloric acid production; constipation; muscle weakness; need for excessive amounts of sleep; lowered resistance to infection; subnormal body temperature; sugar and salt cravings; dependency on caffeine or other stimulants to get through the day.
The symptoms may seem vague and somewhat common to many conditions, and this is where some simple in-office tests may prove helpful in assessing if the adrenals maybe involved.
Blood pressure test (Ragland Test)
Be sure the patient is well hydrated. Take BP while patient is lying down; ensure they have been at rest in supine position for 10 minutes. Have patient stand and take their blood pressure. A normal response will see a rise in BP of 10-20 mm Hg in both systolic and diastolic BP. If the BP drops, it could indicate adrenal fatigue; the amount of drop may represent the severity of fatigue.
The simple act of standing up is a physical stressor to our body as we must ensure oxygen delivery to the brain. This stimulates the hypothalamic-pituitary-adrenal axis to respond, and all the glucocorticoids should be released. Epinephrine and norepinephrine vasoconstrict and cortisol vasodilates, two out of three win and the vessels constrict to ensure the push of blood to the brain so one does not pass out. With adrenal fatigue, the release of epineprhine and norepinephrine is too low and vasoconstriction does not predominate.
Pupillary constriction test
Have patient in a dark room and shine a pen light into the eye. Watch for expected normal pupillary constriction that is maintained. In adrenal fatigue, the pupil will constrict but then cannot maintain the constriction, and the pupil will dilate within two minutes and maintain that for 30 seconds before constricting again. Timing the length of the dilation should be noted and this test can be used to test recovery.
Sergent’s White Line
This may be present in only 40 per cent of those with adrenal fatigue, but is almost always indicative of adrenal fatigue when present. Run a pen cap or tines of a fork along the belly or forearm. This should result in a red mark within 10 seconds. An abnormal reaction occurs when the marks remain white for up to two minutes and may widen.
These tests are rudimentary and serve to be easy, in-office assessments to provide a guide when you suspect possible adrenal fatigue. There are many more sophisticated tests that could be ordered such as four-point salivary test, 24-hour urine collection test and blood hormonal panels. However, these tests can be inconvenient and cost-prohibitive for the patient. Another method of testing that is fairly easy to complete and is inexpensive is a hair mineral analysis. Assessing the sodium/potassium ratios and other imbalances such as copper can provide valuable insight into adrenal function.
The signs and symptoms a patient may present with may also often be mistaken for thyroid dysfunction. This really is not a “mistaken” differential diagnosis seeing how closely the thyroid gland and adrenal gland function in concert. The entire HPA axis is affected and must be considered. This again reinforces the need to view patients as whole body beings versus parts disconnected from one another.
Other key areas to question your patients on would include their immune status, inflammation and use of stimulants such as caffeine, alcohol and sugar, which can wreak havoc on the adrenal glands. Excessive exercise is another area to question; exercising more than 45 to 60 minutes, especially when done vigorously, can lead to adrenal exhaustion down the road. The initial high felt can be the spike in cortisol as it does provide a natural high, but then with time this cannot be maintained. Eventually, with adrenal exhaustion there can be a loss in motivation and even depression.
Lifestyle intervention is truly the answer to correcting adrenal dysfunction. Supplements such as adrenal gland extracts, licorice and key vitamins and minerals such as zinc and magnesium can be suggested to improve adrenal gland health. Targeting energy with B vitamins to assist as important metabolic cofactors may help a patient get over the hump while making other lifestyle changes. Improved quality of sleep when repair work is most active is important and using support nutrients such as lactium, and melatonin may be needed to encourage this.
Diet is one of the most important areas to monitor. The removal of the damaging stimulants and increased need for high quality nutritious foods and protein while reducing any refined carbohydrates is essential.
Tools such as Dr. James Wilson’s Adrenal Fatigue questionnaire are also valuable in assessing your patient’s adrenal health.
If you suspect a patient may be struggling with adrenal fatigue, think simple, easy, in-office tests first as a start to your assessment.
Dr. Victoria Coleman is a 1994 graduate of CMCC and has a BSc in Kinesiology specializing in fitness assessment and exercise counselling. She is also the president of Douglas Laboratories/Pure Encapsulations Canada. You can contact her at
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