Talk:Adrenal fatigue/Archive 1

Archive 1

Proposed deletion

I have removed the prod tag from this article, because Google Scholar, Books, News and Web searches show that this is a frequently discussed syndrome. I don't have the expertise to comment on whether this is a recognised medical condition by mainstream scientists, but the subject is obviously a notable phenomenon - if it is pseudoscience then it should be edited to make that clear. Phil Bridger (talk) 19:42, 26 March 2008 (UTC)

-Adrenal fatigue is a real medical condition. —Preceding unsigned comment added by 122.49.164.153 (talk) 12:20, 22 September 2010 (UTC)

Last time I was suffering from something "fictional" it turned out to be 19 years of undiagnosed diabetes, strangely enough this diabetes is neither type one nor two, but rather a crushing drop or rise in sugar levels totally dependent on my stress levels, yeah I can sit my ass down in front of my computer games and curse my "imaginary disease" for the rest of my life, or I can believe and somehow end this once and for all, it better be real, and if it is, many lives will be lost if its not taken seriously. — Preceding unsigned comment added by 84.48.123.85 (talk) 01:42, 1 October 2011 (UTC)

Delete it if it satisfies you`r ego`s, but this article staying here or not, may decide if this illness is ever taken seriously and cured... or forgotten along with those of us that are just existing, and slowly forgetting how to live life. — Preceding unsigned comment added by 84.48.123.85 (talk) 01:45, 1 October 2011 (UTC)

Just for the record, I oppose deletion of this page. Supplements for "adrenal fatigue" are on the rise, and article on this so-called syndrome are popping up all over the internet on the subject. We need a Wikipedia on this to give people the NPOV story. My mom's nutritionist recommended an "adrenal support' supplement, so I came here for into. Hope someone can find some scientific publications on this. Danski14^(talk) 00:17, 28 May 2012 (UTC)

I think it is pretty much common sense to see, that adrenal fatigue is nothing more than 'adrenal insufficiency light'. It is a shame that it is only medically recognised in its most extreme form, as adrenaline is one of the most important neurotransmitters to mental health and in the body and even light physical non-life-threatening symptoms can cause considerable impairments. It is like only acknowledging Kanner autism but not Asperger's syndrome, or only type I diabetes, but not type II, because the symptoms aren't as severe and people with the lesser condition live a life revolving around avoiding being symptomatic. 77.181.59.147 (talk) 04:32, 1 August 2012 (UTC)

I think you might be confusing adrenaline (epinephrine) with cortisol. As best I can tell, "adrenal fatigue" is postulated to result from a lack of cortisol, not a lack of adrenaline. (Although, admittedly, the physiologic rationales put forth by proponents of this "syndrome" are often vague and sometimes contradictory). MastCell ^Talk 17:52, 1 August 2012 (UTC)

Reinstating proposed deletion

It should be better labeled to not initially induce one to believe it is a valid medical condition. It is absolutely NOT medically recognized and should be noted so somewhere that people quickly looking for information are not misled by an initial run through reading this article. I'm becoming very annoyed with the alt-meds falsifying and manufacturing disorders. This leads to unsafe self-diagnosis which Wikipedia should stand very clear of. The sourcing for information is not even relevant to the article as the citation for the positive underlying facts for this false condition do not even once MENTION this condition. This is a misleading use of citation, and should be purged completely. The cited paper is a discussion on the incidence (not underlying causative) of HPA within a diagnosis of CFS and FM. Someone please review this and wipe this nonsense out of wikipedia. We needn't help sell crap to late night infomercial viewers, because that's the only purpose of this article. (I have no account, but am a regular user of wikipedia, as I don't know the editing process well enough to contribute beyond minor edits, I've declined creating an account, do not use this as a reason to ignore my request please. Someone take a look at this, I feel it to be a dangerous precedent to continue with articles that have supposed medical contribution when in fact they're purely false conceptions. —Preceding unsigned comment added by 76.73.206.120 (talk) 10:50, 3 August 2008 (UTC)

I've edited the article to try to address your concerns by making it clearer that this is not a condition recognised by the scientific community. I still think it's better for us to have an article which states the facts about this supposed condition rather than delete the article altogether, but if you still think that this should be deleted just let me know and I'll start a deletion discussion on your behalf, as that requires a registered user id. Phil Bridger (talk) 12:11, 3 August 2008 (UTC)

Unsigned, your entire comment reads like nothing more than a rant. Wikipedia addresses inclusion on the basis of notability, not editors' opinions on the subject matter.--Warrior-Poet (talk) 17:55, 17 August 2008 (UTC)

I agree with Phil Bridger's last comment that it is better to have the article state factually that the condition is disputed than to delete it entirely from Wikipedia. I was just given this diagnosis by someone and the article is very helpful to my understanding of the controversy surrounding it. It has influenced my thinking a great deal about what advice I have been given and as currently written is very useful as a caution.MarkGss (talk) 14:13, 18 August 2008 (UTC)

Propse Redirect to Addison's disease

Currently this article has numerous problems of content and style. Much of the article is devoted to the weakly-sourced assertion that the subject does not in fact exist. Redirecting to chronic adrenal insufficiency (Addison's disease) would eliminate these problems, and lead readers to useful information. Are there any arguments against changing this entry to a redirect? Verbivorous (talk) 20:42, 23 September 2008 (UTC)

I do not think it should be redirected, simply mentioning Addison's with a link to it is good enough. We need to make sure there is a distinction between "adrenal fatigue", which is not an accepted condition but is still a real term that people want to learn about, and Addison's, an accepted condition that is not the same thing. 96.38.23.130 (talk) 15:22, 6 June 2011 (UTC)

Redirecting to Addison's disease is not an appropriate solution. This article is not about Addison's disease. Part of the issue with the topic is that the title refers to a colloquial or "lay" name for a condition that is still the subject of argument among medical professionals. In Canada and Europe, there is no question that adrenal hypofunction is a real condition; in the U.S., many conventional medical sources deny its existence by virtue of the fact that symptoms are poorly-defined (and overlap with a variety of other conditions) and not detectable by standard blood testing. Salivary testing, which is not fully accepted by conventional endocrinology, is a proposed alternative, but it lacks standardized methodologies and widespread use.

My major concern is that the reversion from the extensive edits I put in back toward a clearly non-neutral stance taking the position that the condition is mythological has reduced, not expanded, the utility of this page for those seeking information. I went to fair lengths to word the changes such that they took no position on the veracity of the disease as an actual condition, even including a high-quality source that flatly states it does not exist in fairly strong language, to ensure that both sides of the argument were represented. Those who take the "adrenal fatigue is a myth" position may believe no argument exists in medicine, but that's not the case -- even at my own physician's office, I've encountered opposing viewpoints from practitioners there. Describing the lack of consensus therefore has merit for this page. I do not wish to start a flame war, but I want to point out that simply squashing the changes that were made is not in keeping with the ethos of this site. Noting that the sources are not of appropriate quality, or that sources are needed in support of specific information, is a fair and justifiable way to register concerns about the quality of the information. Simply removing it wholesale -- particularly given that an effort HAD been made to support the content appropriately -- reflects poor adherence to the Wikipedia guidelines. (User:Fenbeast) —Preceding undated comment added 20:08, 30 August 2011 (UTC).

Against proposed redirect to addison's disease

Adrenal fatigue is *not* addison's disease, it is an alternative/naturopathic description of a non-medical condition. I think a redirect to a specific medical diagnosis as if they were the same thing would confuse the issue horribly. The current write-up is much clearer. I don't understand the argument, also, that wikipedia should not mention alternative or controversial subjects. It isn't a medical encyclopedia after all. Having clear information on commonly used terms and issues is far more useful than excluding them. Papwsbo (talk) 21:05, 26 October 2008 (UTC)

Yes, I agree (though of course I'm the person who re-wrote the article recently). "Adrenal fatigue" is not adrenal insufficiency, and I think it's probably worth making the distinction here. MastCell ^Talk 21:56, 26 October 2008 (UTC)

Hypoadrenia, History and Etiology

While it is true that hypoadrenia is not currently a medical diagnosis it was at one time very much an accepted mainstream diagnosis. In fact, from the late 19th century until some time after World War II, hypoadrenia was prominently featured in leading medical texts both in the U.S. and Europe. This article could be improved by a discussion of how this diagnosis disappeared, and whether this diagnosis was banished for good reason. As an example, "The Practice of Medicine" edited by Frederick Tice of The University of Chicago, Vol. VIII, 1921, available online via Google book search) devotes no less than 10 pages to this disease. He devotes only half as many to Addison's disease, which is listed as terminal hypoadrenia. This work came just a few years after both World War I and the "Spanish influenza" had greatly augmented the usual supply of autopsies in people of all ages, but especially otherwise healthy young men and women who had suffered a variety of fatigue syndromes, some then known by the name of another now banished disease, neurasthenia. While the current Wikipedia article places emphasis on hypocortisolemia as the alleged non-existent cause of this "non-medical condition" (implying that there would need to be a problem with the adrenal cortex and that no such problem is found), these older texts offer no room for doubt that the initial deficiency appeared in the products of the chromaffin cells of the adrenal medulla, not the cortex. They knew this beyond any reasonable question because, as students of the history of endocrinology may recall, the chromaffin cells were so named because chromium salts would react strongly with the epinephrine in these cells and produce a characteristic yellow-brown stain. What these texts discuss is the result of extensive evidence of serious histopathology of the chromaffin cells that ranged from gross morphological changes to the cells easily seen with microscopy to outright rupture of the entire medulla. During the war, there were reports of soldiers dying from exhausting rigors such as forced marches and "shell shock" whose adrenal medullas had infarcted from stress, resulting in death. A very common finding was that patients suffering from "asthenia" had chromaffin cells that would not stain normally. In fact, failure of chromaffin cells to stain normally was considered forensic proof that death was not sudden, but rather the patient was under stress for a considerable time prior to death. It is impossible to escape the conclusion that hypoadrenia was known to be due through all but the final stages to damage to the chromaffin cells leading to an insufficiency of epinephrine and, to a lesser degree, norepinephrine since the latter is also produced in the sympathetic nerves. I find virtually no mention of hypocortisolemia in the discussion of hypoadrenia until one reaches Addison's, and no discussion of histopathological changes to the cortex short of full-blown Addison's or catastrophic destruction of the gland due to some disease process such as tuberculosis. So, stating that hypoadrenia was meant to mean a deficiency principally of cortisol is clearly historically incorrect. Furthermore, these texts refer to this disease by 1921 as being very amenable to treatment either with suprarenal extract, or purified epinephrine, which was sold under the trade name "Adrenaline" in the U.S. Since subcutaneous Adrenaline injections were too short-acting to be a practical long term strategy for supporting the chromaffin cells while they healed, physicians in this era handed out glandular extracts like ketchup to patients with the entire spectrum of fatigue disorders. They report very satifying results. There is also a credible case series of influenza patients who were supported during their illness with both Adrenaline and adrenal extract who had significantly better survival rates and less complicated recoveries. Extensive damage to the chromaffin cells was a very common finding in victims of the Spanish Flu. I have read many texts from this era and it is clear that the existence of this disease was not the subject of controversy in the scientific community, and was a vivid and clear entity in the minds of many of the same researchers who so powerfully advanced medicine during and after World War I. These were experienced, smart people with surprisingly modern tools at their disposal. Also, at least before the mid-twenties, Charcot’s and Freud's theories had not gained widespread appeal in the United States and researchers here were not so quick as they are now to avail themselves of the more efficient ways of disposing of complicated metabolic problems afforded to contemporary medicine by the teachings of these two worthies. Physicians then actually tried to diagnose and treat fatigue syndromes, rather than reflexively to send patients for psychiatric intervention as we do now. I can't help but note that a powerful confidence in the validity of these non-organic explanations for fatigue is what encourages so many people to dismiss diagnoses like hypoadrenia with such a clear conscience. So, how did the considerable knowledge of this condition disappear and how can someone now say that this non-existent disease is due to a non-existent deficiency of cortisol from intact adrenal cortical tissue? Is this some bizarre form of mass medical amnesia, or is it possibly an artifact of medicine's burgeoning love affair with synthetic hormones that displaced glandular extracts ca. 1950-1960? Is it necessary to point out that, if in fact hypoadrenia is real and it is dominantly chronic exhaustion and histological damage to the chromaffin cells of the adrenal medulla, the ACTH stimulation test would be largely inapplicable in the diagnosis of anything but the latest stages of the disease since the endpoint of that test is a measurement of cortisol, not epinephrine? Yet, it is on the strength of such tests that assertions that the disease does not exist are largely founded. True, one can measure serum and urinary metanephrine, but these tests are usually given when pheochromocytoma is suspected and not when trying to sort out ordinary fatigue syndromes. So, do we in fact have any useful screening assay for damaged chromaffin cells that is in common usage, or does the assumption that normal cortisol closes the case prevent us from thinking clearly? How did we become so cortex-centric in our thinking about the adrenals? Also, if this disease in fact was correctly identified over 100 years ago and, remorsefully, a physician sought finally to treat it, what modern medication would she prescribe that would support the chromaffin cells sufficently for them to recover? What epinephrine prep or analog is sufficiently long acting? In fact, what would be available today that would be an improvement over the suprarenal extract that the lowly alt.health practitioners use? I myself am still studying this area with an open mind but with a new-found respect for the fact that the researchers who wrote the texts I refer to came from the generation that had to cope with the first worldwide war and maybe history's largest pandemic, discovered DNA as a direct result of trying to solve the riddle of the Spanish Influenza, and were certain based on solid facts that hypoadrenia was a real and very common medical problem. Zzzzzchecker (talk) 03:41, 31 March 2009 (UTC)

I'm sorry, that was a bit too postmodern for me. This talk page isn't really a forum for general discussion or debate about adrenal fatigue, or about our beliefs about early-20th-century diagnostic methods. Could I ask you to take a look at the talk page guidelines, and use this talk page to concisely discuss specific, concrete changes to the article based on reliable sources? MastCell ^Talk 05:53, 31 March 2009 (UTC)

Thank you. Feel free to edit or delete my comments as you see fit. Zzzzzchecker (talk) 07:38, 31 March 2009 (UTC)

It seems you are very knowledgeable about this issue, so I suggest that you try to improve the article with your information. Just make sure to give a citation to your contributions since this is a controversial topic. I'd love to see the article evolve and reflect the data you provide as well. Mathityahu (talk) 16:29, 31 March 2009 (UTC)

Thank you. I originally accessed this article by entering "hypoadrenia", as part of my research project into the history of endocrinology. However, I now notice that the article seems to be part of an "alternative medicine" section, which I know very little about and for which I have no particular brief. Maybe alternative practitioners use the term hypoadrenia, but to me it is an abandoned mainstream diagnosis of historical interest. Nevertheless I will think about it and thanks for the suggestion.Zzzzzchecker (talk) 19:58, 31 March 2009 (UTC)

Mainstream medicine hasn't abandoned assessment of adrenal function. In fact, a tremendous amount has been learned since the era from which your sources are taken. Adrenal insufficiency is a recognized medical syndrome with a variety of causes at all levels from the brain to the adrenal itself. Reproducible tests which reliably discriminate adrenal dysfunction exist.

One of the advances since the 1920's has been in the understanding of adrenal medullary and cortical function. Symptoms of adrenal insufficiency, including fatigue, are due to adrenocortical dysfunction and deficiencies in cortical hormones (glucocorticoids and, less often, mineralocorticoids). Adrenal medullary dysfunction is much less common. Most importantly, it appears to have minimal clinical impact, especially in otherwise healthy individuals.

How do we know? Well, suppose you have both adrenal glands removed surgically, for example because of bilateral adrenal tumors. Your adrenal medullary function drops to zero. Yet these patients do not suffer from catecholamine deficiencies, probably because of the production of norepinephrine by peripheral nerves and other tissue. There are caveats - for example, the response to severe hypoglycemia may be impaired in diabetics with bilateral adrenal loss, because they often have autonomic neuropathies as well and thus lose both sources of catecholamine production - but by and large, adrenal medullary dysfunction (or complete loss) does not cause the symptoms you're describing.

Sure, in the 1920's pathologists noticed that people who died suddenly under great stress had funny-looking adrenal medullae. But that's a matter of cause and effect - they were living in a high-catecholamine state for a prolonged period of time, eventually leading to death. Prolonged catecholamine excess (not deficiency) is a well-recognized risk factor for sudden cardiac death. The abnormal staining of chromaffin cells was a byproduct of the prolonged high-catecholamine state. Does that make sense?

Oops... now I broke my own rule. MastCell ^Talk 22:37, 31 March 2009 (UTC)

Thank you. Yes, this makes sense in that I also learned that the medulla was physiologically expendable and actually almost a vestigial organ. I learned that adrenalectomized subjects would be right as rain with Cortef and Florinef, although several have expressed alternative views. Moreover, I was taught that 20mg Cortef po ought to tune up the weary and if it didn't, off to the shrink. Epinephrine? Who needs it when you have norepinephrine? Brutal orthostasis despite Tx? Must be autonomic neuropathy, although funny that just now the patient seems to be having Reynaud's in her feet. Oh well, an odd sort of neuropathy, I guess. Chromaffin cells? They turn to mush immediately after death so who knows what they've been doing. They must have been killed off by all the cortisol, although actually they need and thrive on cortisol or else several key enzymes in epinephrine synthesis are immediately inactivated. It is when they are deprived of cortisol that they won't stain. This is clearly the medical orthodoxy, and it certainly is powerful evidence that the lengthy clinical experience of the past has been abandoned and forgotten. I don't know about your experience but my impression is that, if fatigue syndromes are the New York Yankees of medicine we are the Chicago Cubs. This is why I am involved in a research project to begin at the beginning and try to trace all of this carefully through from about 1900 to the present day. I freely admit that I am up to about 1950, so the mystery of how the adrenal glands became only the cortex and the medulla got fired from medicine is still not clear to me. If you don't mind, I think we should wrap this up. What I do is to publish in peer-reviewed archival medical journals when I have solid data and my work is complete. Quite honestly this article seems to be oriented towards denying the existence of an alternative medicine diagnosis based on one reference to something that is little more than a blog. I have one suggestion. Unless you are finding that hypoadrenia is in current usage by alternative practitioners, either delete it from the article or somehow edit the article so that you do not appear to be conflating it with whatever terminology the alternative people are using.68.227.185.167 (talk) 12:04, 1 April 2009 (UTC)

I'm fine with wrapping this up. At present, most of the use of the term "hypoadrenia" seems to be as a synonym for "adrenal fatigue", rather than for an actual medical condition, so I think the current redirect should stay for now as a reflection of the current reality. I do love it when "medical orthodoxy" is altered by new findings, so good luck with your research project. Fatigue and functional syndromes are definitely the black box of medicine, though I think if you discount the role of psychological factors across the board and focus on a purely hormonal explanation, then you're oblivious to reality and the mind-body connection. "Medical orthodoxy" abandons lots of things - no more bloodletting or mercury purgatives for what-ails-you, for example. Most such treatments are abandoned because they reflect an outmoded understanding of physiology - so in the interest of open-minded inquiry, keep that possibility in mind before you conclude that orthodox dogma has capriciously closed the book on "hypoadrenia". Peace. MastCell ^Talk 22:05, 1 April 2009 (UTC)

Well put. Here's the best historical narrative I've found that explains how we arrived where we are[1] . Peace back. Zzzzzchecker (talk) 19:30, 2 April 2009 (UTC)

Thank you for that reference - it's an interesting paper which I had not seen before. MastCell ^Talk 20:17, 2 April 2009 (UTC)

References, and alternative views

There are references that could be used to bolster this page, in which adrenal insufficiency is discussed and assessed. I would like to know from the previous editors of this page whether the impetus for deletion was lack of agreement with arguments put forth in these references (I give a few below) or lack of awareness of these references. Whether this research is controversial, and in what way, could be added as well (if there is any published criticism). I thought the whole point of wikipedia was to make available and tie together various views, when those views can be substantiated by previously published material.

In the following study, 40 out of 64 patients being studied for Chronic Fatigue Syndrome exhibited "overt or subclinical" "hypoadrenalism"

That study describes Dr. William Jeffries (Professor of Medicine at University of Virginia) as "the world's leading clinical expert on subclinical adrenal insufficiency," and recommends Jeffries' book

Later, Teitelbaum did another study, . Trawling through the references, there is another study I've not read but the title suggests further evidence:

It seems to me that these references bear mention in the current article, which could be rewritten to reflect that adrenal insufficiency might be one factor in Chronic Fatigue Syndrome which itself, as you can see from its own Wikipedia entry, is an illness recognized by the CDC, given ICD numbers, and with a substantial amount of literature.

Pedalclav01 (talk) 21:57, 6 October 2009 (UTC)PedalClav01

Further to my previous entry, an article by Holtorf in the Journal of Chronic Fatigue Syndrome 14:3 2008 ("Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM)"), not listed in MedLine to my knowledge, references no fewer than 39 studies (probably many are in MedLine) to support his assertion that,

"The hypothalamic-pituitary dysfunction that is present in the majority of CFS and FM patients results in HPA axis dysfunction that is often not detected by standard testing done in a clinical setting, as these tests are designed to detect primary adrenal insufficiency and have poor sensitivity to secondary or tertiary adrenal insufficiency."

The journals these 39 references come from, discussing subclinical adrenal insufficiency, include:

J Clin Endocrinol Metab
Acta Psychiatr Scand
Biol Psychiatry
Clinical Endocrinology
Psychosom Med
Biol Psychiatry
Psychoneuroendocrinology
J Rheumatol
Arthritis Rheum
J Endocrinol Invest
Arthritis and Rheumatism
Am J Med
Clin Endocrinol (Oxf)
Arch Int Med
European Journal of Endocrinology
Journal of Affective Disorders
Horm Metab Res
Acta Psychiatr Scand

So to the person here who said adrenal fatigue is not a current medical concept, can they please explain? I'm baffled. —Preceding unsigned comment added by Pedalclav01 (talk • contribs) 00:27, 7 October 2009 (UTC)

For what it's worth - I was at the doctor this week and she thinks it is possible that I suffer from Non-Addison’s Hypoadrenia, and has ordered a battery of blood tests to check for it. She is a "normal" doctor, so this disorder can't be that fringe. It may not be recognised by conservative medicine, but neither are the benefits of vitamins or accupuncture despite all of the research into their veracity, so how conservative do you want this article to be? I do recognise, however, that Wikipedia tends to be HYPER-conservative and paleo-orthodox when it comes to medical subjects. 121.73.7.84 (talk) 11:00, 9 February 2011 (UTC)

References

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this article needs to be completely rewritten

Isn't there anybody out there who knows about this topic and is neutral? It's interesting that this article has been censored by mainstream medical proponents into nonexistence. Come on! This is a major alternative medicine theory and it's only got a 2 short paragraphs,and those by someone obviously hostile to it? What is it's history? Who came up with the name and why? what are it's symptoms? what supplements are used by who to treat it? Who opposes it and why? This article has practically no information. Is wikipedia really a place where freedom of speech means editing out opposing views? This article is not neutral. Maybe we could try for something more complete and showing the history of controversy too. I also think that a link to chronic fatigue would be useful as this is probably the medically recognized syndrome closest in symptoms to it.

It's also noteworthy that someone mentions bloodletting as an old abandoned medical procedure, but doctor's are using leeches again in some circumstances. I would also point out that chronic fatigue was not recognized for many years, but now is.So was medicine right before or after? Can any of us say for sure that adrenal fatigue will never be recognized? The science that medicine is based on is always limited to current understanding.

I would also point out that while naturopaths are not allowed to call themselves medical doctors, the profession is still legal. Adrenal fatigue is a valid alternative theory and diagnosis, whether everyone likes it or not. Someone complains that they are sick of people coming up with theories to justify sales of supplements.The exact same complaint has been made about the sales of prescription drugs. I think all of the controversy means the more information in wikipedia the better about both mainstream and alternative medicine.

papwsbo —Preceding unsigned comment added by Papwsbo (talk • contribs) 19:05, 10 November 2010 (UTC)

@papwsbo, it is relevant to the discussion of this article to point out that after repeated experiences I have recognised that Wikipedia tends to be an attack site against alternative and complimentary medicine. Conservative medicine is considered "neutral POV" and sources supporting alternative medicine are usually excluded as non-legitimate sources because they support alternative and complimentary medicine - a catch 22 as they say. My quick internet search indicates that others share my concerns www.naturalnews.com/029939_Wikipedia_bias.html [2][3]. Despite the wikipedia project being seemingly progressive, it actually has a (probably unintended) highly conservative agenda. HansNZL (talk) 11:47, 9 February 2011 (UTC)

Strange no? A condition that does not exist, yet thousands seem to get well from treating it... strangely cortison seems to cure my adhd now, I can sit still and actually type for the first time in... over 25 years. Ironically, until more is proven by some people that dare consider themselves superior simply because they had the right life conditions to finish and end their medical studies, this calm state is just my imagination. Considering I cannot afford more hydrocortison anymore, I suppose doctors will again be proven right.

I miss my family, my job, my life, which none could withstand my symptoms, oh well, soon it wont matter anymore, ill be too busy daydreaming while running around crashing into stuff anyways...

Hopefully someone will recognize this, so I may again wake up, well not wake up, considering I havent slept in years... but rather be given a chance to live rather than exist, or at least rest. — Preceding unsigned comment added by 84.48.123.85 (talk) 01:57, 1 October 2011 (UTC)

Can I ask anyone who would care to update this to take a look at www.drlam.com, he is a medical doctor and provides an excellent in depth understanding of the condition. I believe a large number of people will come to Wikipedia to research the condition and the existing article will only supress their concerns which may be very valid. As someone stated Wikipedia is not a medical encylopedia, it should provide a non biased insight into adrenal fatigue so that the reader can make their own mind up. Essentially what's important is that some seeks the help of a healthcare practitioner and the article should make this point. Simondlh (talk) 11:32, 23 January 2012 (UTC)

This is a very serious subject for me as my sister recently passed away from 12 years of severe Adrenal Fatigue. It was a slow and insidious progression of depression, fibromyalgia, IBS, hair loss, weight loss, etc. Mainstream doctors were useless and she gave up trying to get any professional help. This was not Addison's Disease, it was a slow depletion of adrenal output from continual stress and probably a genetic weakness as well. If you think you cannot die from stress, think again. You can deplete your adrenal output to the point of an equivalent Addison's crisis without having Addison's Disease. Mainstream medicine needs to recognize this. Led99 (talk) 22:28, 24 November 2012 (UTC)

if "adrenal fatigue" could deplete your adrenal output to the point of crisis, it would be easily detected on blood test. One of the hallmarks of the so-far unproven theory of adrenal fatigue, is that reductions in cortisol production are too subtle to be tested using conventional means, and this contradicts your position. FlatOut 12:10, 22 April 2013 (UTC)

This article contains no history, no specific symptoms, no specific causes, no specific treatments. No sources that actually gives specific information about this severe illness. This is a serious illness since my mom also passed away from Adrenal Fatigue. Can you elaborate the details please? --Nancyinthehouse (talk) 05:40, 3 April 2013 (UTC)

As the article makes clear, adrenal fatigue is not a recognized illness or medical condition, but the concept is promoted by a number of alternative-medicine outlets and websites. Because this project is intended to build an encyclopedia based on independent, reliable sources, we cannot uncritically repeat information from dubious websites. While there is no doubt that medically unexplained symptoms can exact a terrible toll, we won't solve that problem by using this website to promote a health claim which is widely regarded as dubious at best. MastCell ^Talk 23:04, 3 April 2013 (UTC)

Belief or Unproven Theory

The reference [4] describes Adrenal Fatigue as an unproven theory, hence my edit to reflect the reference. Agree not a Scientific Theory but probably an Unproven Theory rather than a belief? FlatOut 12:51, 23 April 2013 (UTC)

• I think theory is fine. --evrik ^(talk) 13:44, 30 April 2013 (UTC)
  • Nothing (no theory) in Science or Medicine can be proven absolutely. There is always doubt, no matter how long mainstream medical opinion has considered an illness as real or not. The diagnosis of Adrenal Fatigue is supported by numerous qualified medical doctors, if not necessarily by the medical community in general. — Preceding unsigned comment added by 124.169.216.44 (talk) 14:39, 2 September 2015 (UTC)

We only summarise what reliable sources have to say about a subject. The vast weight of evidence in reliable sources does not support the diagnosis of adrenal fatigue. Flat Out (talk) 04:38, 3 September 2015 (UTC)

Actually, science has quite a lot to say about adrenal fatigue, but it doesn't use that term. The problem with "adrenal fatigue" is that it combines science (i.e. the fact that stress causes reduced adrenal output) with unproven crap like the stuff about taking supplements to cure it. If Wilson stuck to the science he would help a lot more people. --sciencewatcher (talk) 08:53, 3 September 2015 (UTC)

History in alternative medicine

The sources listed in this section are appropriate for the text. --evrik ^(talk) 13:44, 30 April 2013 (UTC)

The condition was first brought to the public eye under the name adrenal fatigue by James L. Wilson, D.C., N.D., Ph.D., in a 2001 book entitled "Adrenal Fatigue: The 21st Century Stress Syndrome." Functional and alternative medical practitioners in the United States generally recognize the condition as valid, though it is considered to be a made-up or mythological disorder by mainstream endocrinologists. Some functional medicine practitioners argue that the lack of acceptance is in part due to the misleading name given the condition, which is better described as adrenal imbalance, or termed more specifically as adrenal hypofunction in cases of low cortisol production, or adrenal hyperfunction in cases of high cortisol production.

References

The new sources appear to be self published sources and not appropriate for this article. Also, the new text appears to be citing the new text to old sources which do not support the new text. Yobol (talk) 00:50, 1 May 2013 (UTC)

I have to agree with Yobol that the sources are not appropriate support for the text that was added. FlatOut 09:30, 1 May 2013 (UTC)

I don't agree. --evrik ^(talk) 00:41, 2 May 2013 (UTC)

Where there is disagreement, consensus needs to be reached before changes are made. Just saying "I don't agree" is not helpful. The ref you cited above for Functional Medicine appears to be a bad link however there is nothing on that site that refers to adrenal fatigue. The reference you cited from womentowomen.com does not provide any evidence that adrenal fatigue exists, except to say it does. See WP:VERIFY. FlatOut 03:07, 2 May 2013 (UTC)

Thanks for the explanation about the sources. It really helped to understand the reason why this is a theory rather than an illness. My doctor who was a big fan of James L. Wilson gave wrong medications and diet which evidently made my "real illness" worst. It wasn't Adrenal fatigue, but it was Addison's disease.--Nancyinthehouse (talk) 07:46, 3 May 2013 (UTC)

Adrenal fatigue does actually exist...

While the quacky supplements peddled by the 'adrenal fatigue' practitioners are undoubtedly a bunch of hogwash, there is actually such a thing as adrenal fatigue (or "functional adrenal insufficiency" to give it its correct name). We have known since Selye's experiments in the 1950s that chronic stress can result in low cortisol, and this is backed up by more recent research into PTSD, as well as animal experiments. Currently the article basically just says 'there is no such thing', which isn't entirely correct. The problem is, how do we explain this in the article without getting into WP:SYNTH? Are there any reliable sources out there that discuss this while specifically mentioning the term 'adrenal fatigue'? --sciencewatcher (talk) 05:06, 17 March 2014 (UTC)

Adrenal fatigue as a term is attached to the hogwash. If there is a recognised condition known as functional adrenal insufficiency and there is supporting evidence for this, then create the article Flat Out let's discuss it 05:47, 17 March 2014 (UTC)

I had a quick look, and it looks like there are no relevant sources we can use. --sciencewatcher (talk) 15:10, 17 March 2014 (UTC)

Adrenal insufficiency

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925266/

--evrik ^(talk) 15:12, 17 March 2014 (UTC)

That review article is only talking about FAI due to being critically ill with HIV. In general AI only deals with low cortisol due to organic disorders. The problem is that since the 1950s nobody has really done much research into AI due to stress. There has been some research in CFS/fibromyalgia, but nobody has pinned it down yet. I don't think we can really say much else here until someone actually bothers their ass and actually looks into this properly :) --sciencewatcher (talk) 15:51, 17 March 2014 (UTC)

I don't think you're correct about the lack of research. There's been a ton of scientific work on the ways that stress affects the hypothalamic-pituitary-adrenal axis. A ton. Robert Sapolsky has basically made a very successful scientific career out of studying the question, among others. There's just no evidence to support the claim that the adrenal glands become "fatigued" as a result of stress (although there is some preclinical work suggesting that cortisol responsiveness is altered by, among other things, upregulation or downregulation of glucocorticoid receptors). MastCell ^Talk 16:29, 18 March 2014 (UTC)

Well there is good evidence that the adrenal glands shrink and/or reduce cortisol output due to chronic stress. I think that is what the alternative therapists are terming 'fatigue', although they're a bit lacking in understand how the HPA axis works. It isn't that the glands themselves become fatigued, but rather that some signalling mechanism tells them to produce less/more cortisol. The last time I checked I think they weren't too sure exactly what causes the increase/decrease in cortisol due to chronic stress. It isn't ACTH, as ACTH remains the same even though cortisol output is drastically changed. Anyway, the point I'm making is that it would be good to give some info on science behind the true "adrenal fatigue" (or whatever the correct name would be). The problem seems to be finding a review that specifically mentions "adrenal fatigue". However given that we're dealing with pseudoscience in the first place, perhaps an article in a reputable science magazine would suffice. --sciencewatcher (talk) 16:44, 18 March 2014 (UTC)

Infobox

My edit to the infobox was reverted by @Flat Out:, and I would like to discuss it. First, I removed the words "Adrenal gland" from the Caption field of the infobox as it already appears twice in the picture (once as a title in the picture, once as a label for the organ). Adding it to the caption adds a 3rd mention of "Adrenal gland", which seems excessive. Secondly, I added a summary to the "claim" portion of the infobox, and was reverted, with an edit summary which implies that the material was removed because it was redundant to the text in the article. This would seem to defeat the purpose of the infobox, which is supposed to include a summary of the material from the article, and leaves the infobox almost completely empty except for a picture, in which case we should just use the picture as illustration, rather than an infobox. I propose we restore the summary and remove the redundant use of the phrase "adrenal gland". Yobol (talk) 12:19, 18 March 2014 (UTC)

• I think it good the way it is. --evrik ^(talk) 14:31, 18 March 2014 (UTC)

Why do we need 3 mentions of the word "adrenal gland" in the box, but no mention of what adrenal fatigue actually is? This isn't the "adrenal gland" page, this is the "adrenal fatigue" page. Yobol (talk) 14:34, 18 March 2014 (UTC)

My problem with the infobox in this article is that it doesn't contain any actual info. For that reason, I agree with Yobol that it doesn't add anything and should be removed. MastCell ^Talk 16:24, 18 March 2014 (UTC)

I think the infobox gives the photo more context. --evrik ^(talk) 20:42, 18 March 2014 (UTC)

What context? The anatomic relationship of the adrenal glands to the kidneys? How is that relevant to this article, as opposed to adrenal gland? Why don't we actually discuss the topic of the article? I am reverting to the previous consensus version of the article where there is no infobox until we can come up with a consensus on what should be in an infobox. Yobol (talk) 21:11, 18 March 2014 (UTC)

I don't have a strong view on this, except to say that the infobox is marked with fringe theory and it isn't doing any harm. Flat Out let's discuss it 22:08, 18 March 2014 (UTC)

I agree. I think the consensus is to keep the box. For now sit least. --evrik ^(talk) 01:54, 19 March 2014 (UTC)

External links

Some of the new external links appear to of dubious use. We should probably only have Wilson's book added to further reading or his website in EL section, not both, as they are basically coming from same source. The womentowomen.com, about.com and webmd.com links are of dubious quality and I would support their removal. Yobol (talk) 15:48, 19 March 2014 (UTC)

• Each of the links is a separate source. Wilson's book is not the same as the website. --evrik ^(talk) 16:01, 19 March 2014 (UTC)

Inaccurate language

Leaving aside for the moment whether the condition is a real or invented disorder (and I want to add the caveat here that there are plenty of disorders, celiac among them, that were considered "invented" until such time as medical pathology uncovered physiologic signs of something real going on -- so it pays to not dismiss anything out of hand), I would like to see a bit more balance in the language used. Specifically:

"The concept of adrenal fatigue has given rise to an industry of dietary supplements marketed to treat this condition. These supplements are largely unregulated in the U.S., are ineffective, and in some cases may be dangerous.[1]

1.) in re: "These supplements are largely unregulated" -- Supplements are not unregulated. They are regulated as dietary aids, rather than medical aids. As such, they are not permitted to make medical claims, and they CANNOT be marketed to "treat" any medical "condition" (recognized or not) — that would be illegal. [See: http://www.fda.gov/food/dietarysupplements/qadietarysupplements/default.htm] Where there is lack of regulation is in composition: no standards exist that say that a preparation purporting to contain, for instance, "Siberian ginseng" must contain a specific concentration of the herb Eleutherococcus senticosus. Thus an alternative wording that would be more accurate is, "There are no standards in place in the U.S. to assure the quality or composition of such supplements."

2). in re: "are ineffective": Effectiveness is clinically unproven because the supplements have, for the most part, been subjected to no large, randomized, controlled trials. That does not, however, mean they are ineffective — the language is scientifically inaccurate, because just as you need a trial to prove something IS effective, you need a trial to prove that it ISN'T, and there have been very few well-powered studies to show either/or for most ingredients in products used in these supplements. Many of the ingredients are drawn from non-Western systems of medicine and have anecdotal support for efficacy, which obviously isn't adequate to prove it from a scientific standpoint, but it should be enough to suggest a need for caution in making unsupported statements about efficacy in regard to multiple herbs and nutrients that are not herein described. For the writer to state flatly that supplements are not effective is inaccurate at best and biased at worst. The only thing you CAN accurately say is "The supplements' efficacy in addressing the symptoms claimed for adrenal fatigue is unproven due to lack of large clinical trials."

3). in re: "in some cases may be dangerous" — that is an inflammatory statement that, again, is not proven. Where is the evidence? The reference cited [1] does not offer any scientific support for the statement this writer makes and contains at least one wild inaccuracy.

It says, direct quote, "doctors are concerned that supplements or vitamins sold as a treatment for adrenal fatigue could hurt you. Some of these supplements contain extracts of human adrenal, hypothalamus (a part of the brain that produces hormones), and pituitary glands and could be harmful. Many of these supplements have not been tested for safety."

I have a LOT of objections into reading this as evidence supporting the potential dangerousness of supplements: for one thing, "doctors" being "concerned" is not, of itself, proof that the supplements are unsafe, nor is a lack of safety testing -- and indeed most of them probably are safe. In fact, at least with respect to the supplements I checked out online, most of the ingredients used are "generally recognized as safe," and won't do any harm to most people unless they prove to be allergic or take more than the recommended amounts (which is true of pretty much anything, be it drug or dietary supplement).

More to the point, there are NO supplements that contain "extracts of human glands" — the FDA would have a freaking FIT if someone were to grind up human organs and sell them as supplements, and rightly so! The products to which this article refers is composed of extracts of ANIMAL gland tissue (usually bovine), and they are NOT supplements — they are FDA-regulated medical drugs logged in the US Pharmacopeia (http://www.rxlist.com/armour-thyroid-drug.htm). So I would strongly question the accuracy of the source given that it gets such a basic, easily researched fact dead wrong. The source itself has no references, no author, and is a clear-cut statement of opinion—yes, from a recognized authority, but it hardly reaches the standard of evidence-based medical information since it cites absolutely no studies in support of its statements. MedEdEPH (talk) 16:52, 19 March 2014 (UTC)

The language is an accurate summary of a high quality WP:MEDRS compliant source. The objections you raise amount to arguing against the source based on your personal experience, which is frowned upon here. If you have other equally reliable sources that state that supplements used for "adrenal fatigue" are in fact efficacious, or are for certain not dangerous, present them. Otherwise, I'm not jumping down this rabbit hole of arguing against with you regarding material that is not even mentioned in this wikipedia article. Yobol (talk) 17:11, 19 March 2014 (UTC)

LEAD

Since this article is somewhat controversial, please do not make changes to the lead without seeking consensus. The meaning of the article is slowly changing without discussion, consensus or considerable change to available sources. Flat Out let's discuss it 03:56, 12 February 2015 (UTC)

Possible source

I found this literature review, which discusses the science behind "adrenal fatigue" (or lack thereof):

http://www.mmimedicine.com/assets/pdf/IntResources1IMCJ_10_4_p26-33_Hypocortisolism_3.pdf

Note that it doesn't appear to be pubmed indexed, and doesn't have any citations, so it wouldn't normally fulfil MEDRS. However given that this subject is pseudoscience, that means we can relax MEDRS. Overall it seems to be a pretty good review of the science, and might be worth using in the article to give readers an overview of the actual science behind hypocortisolism (which I think would be more useful than just saying that adrenal fatigue is a bunch of crap). Comments? --sciencewatcher (talk) 21:04, 15 November 2015 (UTC)

It is published in a non MEDLINE indexed journal, it is written by those with dubious credentials (acupuncturist, and a "fellowship" from a dubious organization) and therefore is of dubious reliability, and I would avoid it. Meanwhile, the source states "current medical research does not support the claim" of the existence of adrenal fatigue, so why are we even discussing it as if it s real in this context? Yobol (talk) 05:02, 1 December 2015 (UTC)

Recent change

In this diff a proposed addition was made citing this source. The source does not appear to use the term "adrenal fatigue" and would therefore be WP:SYN to use here. Yobol (talk) 04:20, 1 December 2015 (UTC)

Ah, sorry, the wrong source was grabbed in the citation. The correct one is the one linked above. I'll fix it now. --sciencewatcher (talk) 04:38, 1 December 2015 (UTC)

Regarding the source: although it's not the best source, bear in mind that this is an altmed/pseudoscience topic, so there are never going to be any really good MEDRS sources. This seems to be a good literature review, albeit not in a pubmed indexed journal, so it seemed a good enough source for the text added. Also, it is the best source we currently have. --sciencewatcher (talk) 05:02, 1 December 2015 (UTC)

The source you provided is not incredibly strong however after my failed attempt to find something better, it is the best we can do. The information is not overly controversial, so I would support using the literature review as a source. Meatsgains (talk) 18:08, 1 December 2015 (UTC)

You probably missed my reply in the section above. I have several issues with the use of this source:

1. It is published in a non MEDLINE indexed journal, which as far as I can tell, doesn't even have an Impact factor. It is clearly not useful for any discussion about what actually occurs in medicine, as it fails WP:MEDRS.
2. It is written by alt med practitioners (an acupuncturist, a physician with a "fellowship" from a dubious organization, and written in an alt med journal. It would only be useful from my perspective for a discussion of what alt med providers in general (or these in particular) feel about adrenal fatigue.
3. Your proposed addition attempts to state what actually happens, not what alt med practitioners believe happen with "adrenal fatigue"; that material needs to come from a MEDRS compliant source, and this does not qualify.
4. This source also would not be useful to describe what believers in "adrenal fatigue" believe, because the authors clearly state that they do not believe in the concept or even in the use of the term. It would only be useful to describe what these authors believe, but that becomes a WP:WEIGHT problem, because why do we care what these particular alt med providers believe, when it comes from a dubioius source to begin with.

Therefore, I do not agree with its use as you propose because it is NOT reliable to discuss "the actual science" because it is not MEDRS compliant, nor is it useful to describe what those who believe in adrenal fatigue believe. It is reliable for the beliefs of the authors, but why would we care (i.e. give any weight) to the beliefs published in a dubious source? Yobol (talk) 19:01, 1 December 2015 (UTC)

Concur. A crappy source that we mustn't use. Alexbrn (talk) 19:22, 1 December 2015 (UTC)

Same here. This source should not be used. It is unreliable. Delta13C (talk) 16:10, 3 December 2015 (UTC)

Introductory sentences are biased toward discrediting this concept

This article comes across as biased towards disproving the subject. At the least, the subject is interesting sociologically. At the most, it is a hypothesis that could tested scientifically. But to immediately start the page by claiming in the first sentence that the subject is "unscientific" is strikingly biased in tone. Keep in mind that many things have not been tested scientifically (and many things are outside the realm of scientific inquiry) and are thus "unscientific." But, that doesn't mean they don't have value as they are and it doesn't mean they won't someday be tested scientifically.

That being said, it is probable, given my understanding, that "adrenal fatigue" has little or no scientific support. I have not done a thorough literature search, so I am not terribly confident one way or the other. I am basing my claim mostly off of a trusted endocrinology association's statement on the matter. But even if it is the case that there is no scientific support, using adjectives like "unscientific" in the first sentence comes across as biased and pejorative. If it is deemed important to describe the scientific evidence in the first sentence, a more descriptive approach would be to say, "... adrenal fatigue has not been scientifically validated ..." Neuroschizl (talk) 20:41, 29 January 2016 (UTC)

No. If something is scientifically bogus, policy dictates it must be prominently described as such. Alexbrn (talk) 21:00, 29 January 2016 (UTC)

If you do a little research, you'll see that it's bogus. Yes, there is hypocortisolism associated with chronic stress / PTSD / CFS, but it has nothing to do with the adrenal glands running out of cortisol. There is actually quite a lot of research on the subject, but Wilson's theories don't seem to be based on any of that science unfortunately. (It would be a lot better for patients if he did base it on the actual science). --sciencewatcher (talk) 00:36, 30 January 2016 (UTC)

Neuroschizl, have a look at WP:PROFRINGE and WP:MEDRS. Delta13C (talk) 00:49, 30 January 2016 (UTC)

class project

My partner and I plan to edit the page on "Adrenal Fatigue" for our class project. We plan to add more information about adrenal fatigue and its controversy, along with its connection to Addison's Disease. Here is the link to my sandbox: https://en.wikipedia.org/wiki/User:Jmagas/sandbox Jmagas (talk)JmagasJmagas (talk) 03:25, 19 April 2016 (UTC)

Please read WP:MEDRS. The sources you are using fail MEDRS. The problem is that there are no MEDRS sources for adrenal fatigue (I've looked quite extensively). I think you are wasting your time doing a class project on adrenal fatigue.

If you're looking for a project, you might want to take a look at the Myofascial pain syndrome and the Myofascial trigger point articles. Those articles are in serious need of an overhaul, and there are some concrete suggestions in the talk page for the Myofascial trigger point article. --sciencewatcher (talk) 15:10, 19 April 2016 (UTC)

Hello, Thank you for the advice. If I made my page less about medical recommendations like "consulting your doctor", do you think that would help improve the content and give it a chance? Best, Jmagas (talk) 17:15, 19 April 2016 (UTC)JmagasJmagas (talk) 17:15, 19 April 2016 (UTC)

No, the whole approach is wrong. You are treating this like it is an actual condition. It isn't. Jytdog (talk) 17:56, 19 April 2016 (UTC)

Disagree This is not scientific 132.234.228.208 (talk) 01:01, 17 May 2018 (UTC)

Requests for this Page

This article is supposed to legitimately discuss a notable and widespread term referring to an alleged condition, if not anything else. 'Adrenal Fatigue' is a term thrown around a lot, and therefore people need to know what it refers to - that's the purpose of this page. The debunking itself will take on a lot more credibility if you are specific in your information about claims surrounding the condition, instead of just repeating 'this is false and there is no evidence' again and again in various different ways.

It's good, for this reason, that there is a bit about who coined the term, and when.

In a similar vein, could people please include some reliable sources on the following: 'symptoms' commonly claimed to be associated with this so-called 'condition' - ostensibly dizziness, nausea and fatigue, among others; purported 'pathophysiology' for the 'condition' - ostensibly that the adrenal glands can't meet the demand for cortisol because, due to chronic stress, the demands are too great; what scientific research has been done or is being done to investigate or debunk these claims - for example, any mass studies testing the blood cortisol levels of chronically stressed people claiming these symptoms or who have received an alleged 'diagnosis' of it, and the findings of said tests; and claimed 'treatments', and some of the specific potential effects they could actually have on peoples' health.

An encyclopedia isn't just a scientific resource; it's also a historical, anthropological, legal, political and cultural one. It can't simply be an exercise in 'it doesn't exist, and if it doesn't exist then nothing concerning it is worth including - NEXT PLEASE'. Even mermaids, telekinesis, unicorns and Atlantis have better Wikipedia entries than that. 86.162.9.182 (talk) 18:35, 14 November 2019 (UTC)

 Done From the sources we know that the supposed condition itself has no stable definition, and no set of defined symptons. I have added something to that effect. With unicorns, we at least have a well-defined (if imaginary) concept! Alexbrn (talk) 18:40, 14 November 2019 (UTC)

Pseudo scientific

There has recently been changes to this article removing it from a pseudo scientific category to a mainstream medical condition. Which from my readings is not making this article more accurate but it is creating a false narrative that is not based on reliable sources.--VViking_TalkEdits 15:07, 22 February 2021 (UTC)

Yes. In response to the person making the edits: there is a difference between functional hypocortisolism after stress (a real thing), and "adrenal fatigue" (psuedoscience). Adrenal fatigue says that the adrenal glands become depleted (which isn't what happens...the HPA axis reduces signalling to the adrenal glands). It also says that you can cure it with supplements (which is obviously ridiculous, as there is no problem with the glands themselves). The refs added are either unreliable sources for medical claims (e.g. the Guardian, see WP:MEDRS), or don't mention adrenal fatigue (see WP:SYNTH). The material added should go instead into articles about the HPA axis and chronic stress, unless you can find a review of adrenal fatigue which explains all of this (I looked a while ago and didn't find any). --sciencewatcher (talk) 18:00, 22 February 2021 (UTC)