What is adrenal fatigue?

The term “adrenal fatigue” is used by some integrative and naturopathic healthcare providers —those who incorporate a wide variety of nontraditional techniques to care for people — to describe what they consider to be the effects of chronic stress.

The adrenal glands are tiny organs above the kidneys that manufacture a variety of hormones your body needs to thrive — including the hormone cortisol, which is released when you feel stress.

Some in the naturopathic community support the idea that long periods of stress overwork the adrenal glands and cause them to stop functioning well, which they believe in turn causes adrenal fatigue.

These practitioners list the main symptoms of this condition as ongoing fatigue and an inability to manage stress. Other symptoms that are often cited include:

Disorders of the adrenal glands exist, but adrenal fatigue specifically isn’t recognized as one of them by most traditional doctors. This includes those who specialize in the adrenal gland. This is because currently there’s no reliable research to support the idea of adrenal fatigue.

As a result, many medical professionals question the value of adrenal fatigue tests, and insurance companies may not pay for such testing unless it’s also done in connection with a recognized condition.

If your practitioner has recommended adrenal fatigue testing, consider getting a second opinion. Unnecessary tests can mean increased costs, delayed diagnosis for a different condition, and additional testing.

If you choose to proceed with your practitioner’s recommendation, read on to find out what that testing might include.

Practitioners who test for adrenal fatigue believe that lower-than-normal cortisol levels are a hallmark of the disease.

However, cortisol, and other hormone levels, fluctuate based on time of day and month. Hormones also interact with each other, so thyroid hormones are often tested as well. Your thyroid is a butterfly-shaped gland in your neck that regulates growth, metabolism, and a range of bodily functions.

The tests listed below are usually ordered when a person’s symptoms suggest an adrenal, pituitary, or thyroid problem or other medical condition that indicates a hormone inbalance. You may want to get a second opinion for any abnormal test results if your practitioner uses this information to support a diagnosis of adrenal fatigue.


Cortisol is a steroid hormone that is made by your adrenal glands. When you face a stressful situation, adrenocorticotropic hormone (ACTH) is released in your brain, telling your adrenal glands to release cortisol and adrenaline, which prepare your body to cope with stress.

Cortisol levels can be tested through blood, urine, or saliva.

Thyroid stimulating hormone (TSH)

TSH is a hormone made by the pituitary gland, located in your brain. This gland instructs your thyroid to produce and release the thyroid hormones triiodothyronine (T3) and thyroxine (T4), which your body needs to function well.

Testing TSH provides a good indication of whether your thyroid may be producing too many hormones (hyperthyroidism) or not enough (hypothyroidism).

Free T3 (FT3)

Most of the thyroid hormone T3 binds to protein. The T3 that doesn’t bind to protein is referred to as FT3, and it circulates freely through your blood. An FT3 test can provide insight into thyroid or pituitary conditions when your TSH is abnormal.

Free T4 (FT4)

The thyroid hormone T4 also comes in bound and free forms. FT4 tests indicate how much active T4 hormone is circulating in your blood.

Similar to T3 testing, measuring T4 can provide insight into thyroid and pituitary health. It’s a common follow-up test when TSH levels are abnormal.

ACTH hormone test

ACTH is made by the pituitary gland and regulates levels of cortisol. An ACTH test can measure blood levels of this hormone. Abnormal results may provide clues about pituitary, adrenal, or lung diseases.

DHEA-sulfate serum test

Dehydroepiandrosterone (DHEA) is another hormone that’s released by your adrenal glands. A DHEA-sulfate serum test can detect DHEA deficiency, which typically has been related to poor mood and low sex drive. However, a recent study questions the role of DHEA levels on mood.

Since scientific research hasn’t shown adrenal fatigue to be an official diagnosis, it isn’t recommended that you carry out adrenal testing at home.

However, if you choose to do so, depending on your state’s laws, you may be able to order the tests online.

These include cortisol and glucocorticoid stimulation or suppression tests, which are frequently ordered by doctors to diagnose diseases of the adrenal glands, as well as the thyroid, ACTH, and DHEA tests.

Neurotransmitter tests, which require a urine sample, are often marketed for this purpose too, but scientists say the urine results aren’t reliable.

Endocrinologists are scientists and doctors who treat and research diseases of the glands and hormones. According to the Endocrine Society, which is the largest organization of endocrinologists in the world, adrenal fatigue isn’t a legitimate diagnosis.

Members of the society are concerned that a person diagnosed with adrenal fatigue might stop seeking a more accurate diagnosis. They also worry that people who believe they have adrenal fatigue will take cortisol, which could pose a health hazard.

However, some practitioners do advocate treatments that happen to be good for your health in general, such as the adrenal fatigue diet.

Endocrinologists stress that adrenal fatigue isn’t the same as the scientifically proven disease adrenal insufficiency, also known as Addison’s disease. People diagnosed with adrenal fatigue don’t have the same symptoms and don’t meet the diagnostic criteria for Addison’s.

There is a stage of adrenal disease prior to full-blown adrenal insufficiency that is “subclinical,” before the disease becomes serious enough to require treatment.

This pre-disease state may be what people are looking at when they suspect adrenal fatigue. However, calling this stage adrenal fatigue isn’t medically accurate.

Some signs and symptoms of adrenal insufficiency include:

If you’re worried that you have adrenal fatigue, chances are that you’ve been tired a lot, with body aches and pains, depression or anxiety, and perhaps some sleep or digestive issues.

Other conditions can cause these symptoms, and you should discuss them with your doctor. These include:

Some naturopathic and holistic practitioners believe that chronic stress can cause adrenal fatigue. However, because of the lack of scientific evidence it’s not an accepted diagnosis in the mainstream medical community.

Experts instead encourage testing that focuses on medically accepted adrenal, pituitary, and thyroid diseases.

If early tests don’t yield any clear explanation, continue to work with your doctor until they arrive at a diagnosis. In the meantime, it may aid your overall health to follow the adrenal fatigue diet, regardless of consensus on the condition itself.