Adrenal fatigue and Addison’s disease are two different conditions that affect the adrenal glands. While they share some similarities, there are important differences between these conditions.
What are the adrenal glands?
The adrenal glands are small glands that sit on top of the kidneys. They produce hormones that help regulate metabolism, immune function, blood pressure, response to stress, and other essential processes in the body. The main hormones produced by the adrenal glands are:
- Cortisol – the “stress hormone” that helps regulate metabolism and immune function
- Aldosterone – regulates blood pressure and electrolyte balance
- Adrenaline – the “fight or flight” hormone that increases alertness and heart rate
Healthy adrenal glands constantly adjust the production of these hormones to meet the body’s needs. However, if the adrenals become impaired, hormone levels can become imbalanced.
What is adrenal fatigue?
Adrenal fatigue is a term applied to a collection of nonspecific symptoms such as body aches, fatigue, nervousness, sleep disturbances, and digestive problems. It is thought to occur when the adrenal glands become overworked and unable to keep up with the body’s demands.
This concept emerged in the 1990s as an alternative explanation for nonspecific symptoms in patients with normal adrenal function tests. Adrenal fatigue is not an accepted medical diagnosis but rather a term used by some alternative medicine practitioners.
Proponents of adrenal fatigue believe it develops in stages:
- Stage 1 (Alarm reaction) – The body is under stress, cortisol levels are elevated but return to normal when the stress passes.
- Stage 2 (Resistance) – The body remains under chronic stress. The adrenals overcompensate, causing cortisol levels to remain elevated over a long period of time.
- Stage 3 (Exhaustion) – The adrenals become fatigued from chronic stress. Cortisol levels are low and the body has difficulty responding to any further stress. Symptoms occur.
However, these stages do not correspond with any medical or scientific definition of adrenal dysfunction. There are no standard lab tests that can diagnose adrenal fatigue. Normal results on adrenal function tests exclude a diagnosis of adrenal insufficiency.
Symptoms of adrenal fatigue
Common symptoms attributed to adrenal fatigue include:
- Fatigue
- Body aches and pains
- Salt and sugar cravings
- Difficulty concentrating
- Brain fog
- Low libido
- Insomnia
- Lightheadedness
- Digestive issues
- Irritability
- Anxiety or depression
- Hypersensitivity to cold
However, these vague symptoms can have many potential causes beyond adrenal impairment. They are not enough to diagnose adrenal fatigue in the absence of abnormal adrenal function tests.
What is Addison’s disease?
Addison’s disease, also called primary adrenal insufficiency, is a real medical condition. It occurs when the adrenal glands are damaged and unable to produce enough cortisol and aldosterone.
In Addison’s disease, the adrenal glands are often harmed by an autoimmune reaction, where the body’s immune system mistakenly attacks the adrenal tissues. Other potential causes include:
- Infections like tuberculosis, fungal infections, or HIV
- Bleeding into the adrenal glands
- Cancer cells spreading to the adrenals
- Surgical removal of the adrenals
- Congenital adrenal hyperplasia
- Certain medications
Addison’s disease is quite rare, affecting only around 1 in 100,000 people. Because the condition develops slowly, symptoms are often ignored until the disease is advanced.
Symptoms of Addison’s disease
Symptoms of Addison’s disease may include:
- Extreme fatigue
- Muscle weakness
- Weight loss and loss of appetite
- Severe nausea, vomiting, and diarrhea
- Dehydration and low blood pressure
- Salt cravings
- Hypoglycemia
- Irregular heartbeats
- Darkening of skin
- Abdominal pain
- Depression and irritability
- Body hair loss
- Low libido
- Hyperpigmentation
Some symptoms, like fatigue and nausea, overlap with the vague complaints of adrenal fatigue. However, Addison’s also causes more distinctive symptoms like hyperpigmentation and hypotension. Attacks of severe pain, vomiting, and diarrhea are characteristic of Addisonian crises in advanced cases.
Diagnosing adrenal fatigue vs Addison’s disease
While the symptoms of adrenal fatigue and Addison’s disease may seem similar initially, the diagnostic process reveals key differences:
Adrenal Fatigue | Addison’s Disease |
---|---|
Not an accepted medical diagnosis | Established medical diagnosis |
No specific diagnostic criteria | Diagnostic criteria based on signs, symptoms, and adrenal function tests |
Routine adrenal function tests are normal | Adrenal function tests show low cortisol and aldosterone |
No autoimmune reaction detected | Often features autoimmune destruction of adrenal glands |
Symptoms are nonspecific | Hallmark symptoms include hyperpigmentation and Addisonian crises |
There are no standard diagnostic criteria or tests for adrenal fatigue. Mainstream endocrinologists do not recognize it as a distinct disorder.
In contrast, Addison’s disease can be diagnosed with adrenal function blood and stimulation tests, along with signs of adrenal insufficiency on exam. These evaluations are necessary to confirm Addison’s, as symptoms alone may not be enough.
Adrenal function tests
Tests used to assess adrenal function and help diagnose Addison’s disease include:
- Cortisol level – Morning cortisol is typically low in Addison’s disease. May require multiple measurements.
- ACTH stimulation test – Injecting ACTH hormone should stimulate release of cortisol. Poor response indicates impaired adrenal function.
- Cortisol stimulation test – Measuring cortisol before and after stimulation from a medication like cosyntropin.
- Aldosterone level – Low aldosterone is common in Addison’s disease.
- Renin activity – High renin activity indicates impaired aldosterone production.
- Sodium and potassium – Addison’s often causes low sodium and high potassium.
- Antibody testing – To identify autoimmune reaction against adrenal cells.
Through these investigations, the reduced adrenal hormone levels and adrenal dysfunction of Addison’s disease can be confirmed.
Treatment
The mainstream treatment approaches for adrenal fatigue and Addison’s disease are also quite different:
Adrenal fatigue treatment
Those who believe in adrenal fatigue may recommend:
- Reducing and managing stress
- Getting enough rest and improved sleep habits
- Trying dietary supplements like licorice root
- Adrenal extract supplements
- Herbs like ashwagandha or rhodiola
- Hydrocortisone supplementation if deficiency is suspected
- Identifying and addressing nutrient deficiencies
- Mind-body techniques like meditation or yoga
However, there is little high-quality evidence that these treatments can resolve vague symptoms attributed to adrenal fatigue. Most mainstream doctors do not recommend evaluating or treating adrenal fatigue as a distinct condition.
Addison’s disease treatment
Treatment of Addison’s disease involves:
- Hormone replacement – Taking daily hydrocortisone and fludrocortisone medication to replace insufficient cortisol and aldosterone.
- Salt supplementation – Increased salt intake helps maintain blood volume.
- Stress dosing – Temporarily increasing medication doses during illness or surgery.
- Emergency injection – An injectable corticosteroid preparation for adrenal crises.
- Treatment of underlying cause – Such as tuberculosis medications if an infection caused the adrenal impairment.
With lifelong adherence to replacement hormones, those with Addison’s disease can live healthy lives. However, the condition requires careful medical management.
Conclusion
Adrenal fatigue and Addison’s disease share some general symptoms like fatigue, weakness, and salt craving. However, adrenal fatigue lacks a sound scientific basis while Addison’s has distinct diagnostic features and established treatment protocols.
Key points of distinction include:
- Adrenal fatigue is not an accepted medical diagnosis, while Addison’s is an established adrenal insufficiency disorder.
- Addison’s causes measurable dysfunction and reduced hormone levels that adrenal fatigue does not.
- Addison’s has characteristic symptoms like hyperpigmentation that adrenal fatigue lacks.
- Addison’s requires hormone replacement treatment; adrenal fatigue treatment is controversial.
While adrenal fatigue proponents believe the adrenals can become exhausted by chronic stress, this cause is speculative. Standard testing identifies no appreciable adrenal dysfunction. In contrast, Addison’s disease has well-defined causes, symptoms, and treatments supported by the medical literature.