Medscape article: 'Just a Myth'? It May Be Time to Take Adrenal Fatigue Seriously, 2019, by John Watson

[Trish]

https://www.medscape.com/viewarticle/909677?src=wnl_edit_tpal&uac=254766SG&impID=1902143&faf=1

'Just a Myth'? It May Be Time to Take Adrenal Fatigue Seriously
John Watson

Talks about how common fatigue is as a presenting symptom, and lots of patients picking up the idea of 'adrenal fatigue' ... Mentions CFS as a presenting condition that is included in this.

...
In endocrinology, this timeworn narrative has seen its most recent occurrence in the emergence of adrenal fatigue, a condition that mainstream medicine almost uniformly agrees does not exist, at least as it's commonly described.

Yet like so many other areas of modern life, scientific certainty has not proven to be the panacea it once was. Adrenal fatigue has been particularly immune to counterarguments, as evidenced by the growing cottage industry of supplements and off-label treatments meant to treat it, despite their carrying very real health risks.

This has led some to question whether simply labeling adrenal fatigue a "myth" is having the unintended effect of making patients feel unheard, pushing them further into the hands of dubious practitioners.
...

Goes on to explain that stress causes more, not less cortisol to be produced, and there's no evidence of such a thing as adrenal fatigue. Corticosteroid treatment in such situations can be dangerous, and some supplements aimed at this problem are contaminated with thyroid or adrenal hormones.

 

[Estherbot]

One of the Drs in the UK who flirts with adrenal fatigue is Sarah Myhill.

In CFS/ME there is a general suppression of the hypothalamic/pituitary/adrenal (HPA) axis, often associated with adrenal fatigue. Indeed, as we age we all experience declining function in these departments!

http://www.drmyhill.co.uk/wiki/Common_Hormonal_Problems_in_CFS_-_Adrenal

As the Medscape article above says, researchers into ME/CFS have long looked at the HPA axis but not found anything particularly conclusive.

Interestingly Myhill quotes a study from KCL to justify prescribing hormones & steroids.

https://www.ncbi.nlm.nih.gov/m/pubmed/9989716/

The authors are none other than Simon Wessely & Anthony Cleare!

 

[Eagles]

From “Magical Medicine: How to make a disease disappear” by Professor Malcolm Hooper -

http://www.margaretwilliams.me/2010/magical-medicine_hooper_feb2010.pdf

Page 12 - there is evidence of abnormality of adrenal function, with the size of the glands being reduced by 50% in some cases

Page 110 - adrenal insufficiency with subsequent low cortisol levels (Addington 2000)

Page 136 - According to Cheney, it is difficult to talk about a low cardiac output without talking about the involvement of the brain and the adrenal glands.

If the cardiac output goes down, in order not to die, there is a rise in noradrenergic tone (also involving the adrenal glands) to bring the output back up. In ME/CFS, this is a serious problem, because when the adrenals are exhausted, there will be low cardiac output.

There is no such thing as an ME/CFS patient who is NOT hypothyroid: this has nothing to do with thyroid failure, but everything to do with matching metabolic demand and cardiac output.

Page 148 - We suggest that the hyper‐responsiveness of the adrenal cortex to ACTH in patients with (ME)CFS reflects a secondary adrenal insufficiency in which adrenal receptors have become hyper‐responsive to inadequate levels of ACTH. (Mark A Demitrack et al. Journal of Clinical Endocrinology and Metabolism 1991:73:6:1224‐1234).

Page 149 - In a study examining abnormality of adrenal function, Japanese researchers found that “these abnormalities are quite different from those found in patients with mental or physical diseases reported previously” (Yamaguti K et al. JCFS 1996:2:2/3:124‐125).

Page 149 - The cardinal findings include attenuated ACTH responses to CRH and low 24‐hour urinary cortisol. These are compatible with a mild central adrenal insufficiency. ” (LV Scott TG Dinan. JCFS 1996:2:4:49‐59).

Page 150 - “The right and left adrenal gland bodies were reduced by over 50% in the (ME)CFS subjects, indicative of significant adrenal atrophy in a group of (ME)CFS with abnormal endocrine parameters” (Scott LV et al. Psychoneuroendocrinology 1999:24:7:759‐768).

Page 151 - reduced adrenal responsiveness to ACTH exists in (ME)CFS (Srp Arh Celok Lek 2003:131:9‐10:370374).

 

[Hutan]

I thought this article was good.

This is not the case with adrenal fatigue, as was reported in a 2016 systematic literature review in which the authors scrutinized nearly 60 studies analyzing cortisol levels and the adrenal axis in this condition. They concluded that the studies offered consistently conflicting results and inappropriate conclusions made on the basis of highly flawed designs that used unsubstantiated cortisol assessments.

From what I have seen of studies of cortisol levels in people with ME,

consistently conflicting results and inappropriate conclusions made on the basis of highly flawed designs

is a fair summary.

 

[Estherbot]

If you want an introduction to the HPA axis and the stress response, try this article.

https://www.integrativepro.com/Resources/Integrative-Blog/2016/The-HPA-Axis