You can try searching http://www.ncbi.nlm.nih.gov/pubmed/ the National Institutes of Health database of references and abstracts on life sciences and biomedical topics. It now contains more than 20 million citations for biomedical literature from MEDLINE, life science journals, and online books.

A search of pubmed for "adrenal fatigue" brings up only three results.

The first is an interview with a doctor. This has no article linked to it.

The second is a review article from the Alternative Medicine Review journal on Nutrients and botanicals for treatment of stress.

The third is an abstract of a paper on the Adrenal responses to chronic and acute water stress in Japanese quail

There are many good reasons for studying cortisol in all sorts of conditions and adrenal insufficiancy is a well researched disease. Pubmed is full of papers looking at cortisol and adrenal function related to all kinds of health problems. However "adrenal fatigue" as a condition does not currentlly appear to have any research to back it up.

This is the first website that comes up searching google.co.uk for "adrenal fatigue".

http://www.adrenalfatigue.org/

This quote on the front page caught my eye:

Are You Experiencing Adrenal Fatigue?*

• Tired for no reason?
• Having trouble getting up in the morning?
• Need coffee, colas, salty or sweet snacks to keep going?
• Feeling run down and stressed?

If you answered "yes" to one or more of these questions, you may be experiencing adrenal fatigue.*

Seriously?

If you tell people to reorganise their life, reduce their stress levels, eat a better diet and get more sleep it is not unlikely that they will feel better. Of course if you can invoke a disease like "adrenal fatigue" requiring you to buy books, cds, salivary cortisol tests and a range of expensive dietary supplements you can make a lot more money from people.

My understanding is that what is commonly referred to as adrenal fatigue is a state where your hormones adrenalin and cortisol are abnormal, but not to the point of more several hormonal disorders such as Addison's. When my cortisol was tested over a day by a saliva test, I received a diagnosis of adrenal fatigue because the levels were half of what they should have been over the entire day.

In the 2001 bestseller mentioned above, the author points out that AF is a general diagnosis. According to the book, AF is caused by stress, blood sugar instability (high insulin), lack of sleep . . . basically factors that lead you to be tired and chronically unwell. The best medicine for AF is diet that stabilizes blood sugar, ample sleep at night, reduced stress, and decent exercise. AF is becoming almost too popular of a diagnosis, however this might not be bad if there is some recognition that the high stress, awful diet, no sleep lifestyle is one that leads to hormonal imbalances and poor health.

This is valid question that I'd like to see substantiated. The scientific literature is lacking on the topic. I've tried to research this myself and came up with nothing substantial. It seems very hypothetical to me. One thing I am aware of that is somewhat related is with the over-usage of glucocorticoids (i.e. prednisone) where the adrenals can atrophy so adrenal fatigue is plausible, also similar in a way to beta-cell burnout in the pancreas via insulin over-secretion.

I've been diagnosed with it (based on symptoms and muscle testing), but I'm not certain it exists either -- at least as a root condition and not a symptom. Obviously it makes sense that the adrenals could suffer dysfunction like any other part of the body. But the laundry list of symptoms blamed on adrenal fatigue could fit so many other things, like hypothyroidism, clinical depression, sleep apnea, etc. So who really knows? If I rub my adrenals (or the spots on my stomach that I was told represent them) they're very sore, but are they the cause or the symptom? In other words, if my adrenals are fatigued, is that the root of the problem, or a sign that something else going wrong is overworking them?

Recently, I'm seeing talk about dysfunctional cortisol rhythm, where it's not that the adrenals can't keep up, but that they produce too much cortisol at some times and too little at others, sometimes backwards from what the body needs. Maybe that's caused by inflammation, so it's really "inflamed adrenals" rather than "adrenal fatigue."

This is a hot topic and I would like to add my $0.02.

My answer to the question, "Does adrenal fatigue exist?" is "Yes, but..."

About 10 years ago, I started experiencing various fatigue and depression symptoms. First, it was daytime sleepiness. Then, it was depression and poor short-term memory. Over the years, it got worse. This all happened in my early 20s, the time when I should be at my peak.

I saw numerous doctors and therapists of different stripes, both mainstream and "alternative" with almost no relief to speak of what-so-ever.

Finally, about two years ago, I saw a doctor who recommended James Wilson's "Adrenal Fatigue: The 21st Century Stress Syndrome." I tried the high dose vitamin C, adrenal glandular, and some of the herbs he recommends. However, I did not respond to them very well.

As far as lab measurements, the my testosterone was low-normal and my white-blood-count was low normal. My doctor said that this was cause for concern. Also, I noticed that my body temperature was consistently low (in the 95s to 97s), just as James Wilson said it would likely be in the case of adrenal fatigue.

Later on, I got in touch with another doctor who seemed to have more experience with this sort of thing. He recommended a test called the CD57. This test came back way low which he said is a sign of chronic Lyme disease. (I realize that this is yet another non-mainstream diagnosis.) Unlike some other doctors who treat Lyme disease, he recommends treating Lyme herbally.

I tried the herbal regimen that he recommends: the "Buhner Protocol". Within a few months, I suddenly became very sick for a few days (a herx reaction, perhaps?). I was mostly bedbound for the worst of it. Within a few more months, I was consistently feeling somewhat better, but not 100% healthy. I was still experiencing my symptoms, but the symptoms were less severe.

Over a year later, the doctor suggested adding some things to my herbal protocol. He suggested that I could have a Babesia co-infection; other herbs can treat that. He recommended another herb called cryptolepis and a multi-herb formula known as "A-Bab". I recently started with these, and have been feeling somewhat better.

I'm certain that some folks would say that this is all likely a placebo effect, but I disagree. For starters, I feel much better and I can tell a big difference vs. trying things that didn't work. Finally, now that I'm feeling somewhat better, I find that my body temperature consistently measures higher (high 97s to low 98s).

James Wilson did say in his book that many cases of adrenal fatigue may be caused by another underlying condition, so my experience is consistent with what he has to say.

I realize that my story cannot provide a complete answer to the question being asked here, but I hope that it will be useful!

Amazon reviewers have gone nuts for this 2001 book, but I wouldn't put too much stock in that myself. When I see "alternative medicine," I'm already out the door.

Hypothalamic–pituitary–adrenal axis dysfunction is a real condition that scientists study. Adrenal fatigue seems to have been made up by alternative health practitioners reading papers about it, particularly about Addison's disease and they seem to posit a mild form of that. There is some clinical evidence from abnormal cortisol readings. When I had symptoms of so-called adrenal fatigue I was tested for Addison's and I didn't have it. Proponents of adrenal fatigue typically claim such tests aren't sensitive enough to detect adrenal fatigue, which is awfully convenient. Oh, and they have some supplements that treat it for only $29.99! If I had been treated by one of those quacks I'd probably still be sick, luckily I worked with a real doctor and was diagnosed with severe hypotension and started treating that with great success.

Are we distinguishing between adrenal insufficiency and adrenal fatigue?

I believe the former can be detected by orthodox testing and is often treated with low-dose hydrocortisone at levels that aren’t supposed to atrophy the adrenals glands.

Dr Lam’s site has some compelling articles, however none of his information is referenced or backed up by studies.

http://www.lammd.com/articles/adrenalexhaustion.asp?page=1

Despite sounding impressive and believable there is a financial engine behind it, like so many alternative practitioners.

So I’m a bit undecided. Dr Walsh’s theory, which sounds a little more compelling is that there is a signaling problem from the hypothalamus resulting in too high or too low cortisol, rather than a genuine ‘wearing out’ of the adrenal glands.

I’m not too convinced of the at home saliva test. I think it has the potential to worry people who’s health isn’t that bad (bit like the food intolerance testing) or conversely for those that are quite sick with chronic illness, doesn’t offer a complete enough picture.

shrugs

Just a thought...people are very quick to accuse complementary therapists of being driven by money...uhh what about the pharmaceutical companies? that is much bigger business! I have been diagnosed with depression caused by work related stress for the last 2 years, and am now on an antidepressant that will improve my noradrenalin function- the 'latest' effective meds (SNRIs rather than SSRIs) for depression. Thing is, I haven't had negative thoughts for ages, just totally fatigued- so is it actually depression any more, or is it just my body being totally wiped out by the constant fight flight state I was in. I will be very interested to see how my body responds to the new meds.

Anything biologically driven will suffer from fatigue if pushed perpetually. This goes all the way down to the mitochondria. Just like the pancreas fails after being slave driven while holding the world on it's shoulders. However, this will lead to an argument over aliens existing.

Looking for proof on hypoadrenia, have you looked at the book Safe Uses of Cortisol by William Jeffries? By the way I sent you an email yesterday.