Adrenal Gland Problems

The Adrenal Gland
The adrenal glands are two small glands which ‘sit’ on top of the kidneys. Literally the ‘ad-renal’ glands. Proper function of the adrenal glands is critical to health and well-being. There are two parts to the adrenals: the adrenal cortex (producing cortisol, DHEA, and some sex hormones) and the adrenal medulla (producing adrenaline the fight-or-flight hormone). If the adrenal glands become so weak that they can producing hardly any cortisol this condition is described as Addison's disease. The glands produce cortisol, DHEA, Many doctors who have expert knowledge in treating ME and fatigue consider that there is a patient group whose condition is not severe enough to satisfy the diagnostic criteria for Addison's disease but who, nevertheless, are unable to produce adequate amounts of cortisol. Various terms are used such as ‘adrenal fatigue’, ‘adrenal exhaustion’ or ‘function hypoadrenalism’ are sometimes used.

What Symptoms might suggest an Adrenal Gland problem?
Cold hands and feet, constantly low blood pressure, general weakness, needing to eat very frequently, problems standing still rather than walking (e.g. standing in a queue is usually much more of a problem than walking), poor stress resistance, sometimes low body temperature or recurrent infections. The is also a group of hypothyroid (low thyroid) patients who get weaker and suffer symptoms such as palpitations when started on thyroid treatment and some of this group may have subtle adrenal under-functioning. These patients may remark something along the lines of "I was started on thyroxine/armour thyroid and I immediately felt worse and began to have palpitations and feel weak and so I stopped the thyroid medication". Many individuals who have low adrenal function may be very tired in the morning (as may be a lot of hypothyroid patients) and take a long time to 'get going'. [Link: Further information on the Thyroid Gland]

How may adrenal gland function be tested?
The standard medical adrenal stimulation test for Addison’s disease is administered to most patients complaining of severe fatigue. Diagnoses of Addison’s Disease is extremely rare. There is another group of patients who have many of the symptoms Addison’s Disease but whose test fails to show up any problem. Although salivary cortisol testing is controversial there is evidence that it may be a reliable indicator of cortisol levels with the additional benefit that the patient can carry out the test whilst going about their daily routine. This test is useful as an adjunct alongside the standard medical tests for adrenal function.For these patients ‘caught in the middle’ testing of cortisol levels in the saliva using a home kit at 8AM, midday, 4PM and midnight may be useful in helping solve their fatigue problem.
As a general rule it is probably not medically sensible to decide too quickly that a patient should have cortisol replacement. It is important to, as a minimum, at least check salivary cortisol levels if a diagnosis of functional hypoadrenalism is being seriously entertained.