Beyond Adrenal Fatigue: From Anecdotal to Evidence Based Medicine

Today’s clinician is becoming increasingly aware of the detrimental effects of stress on the morbidity and mortality of their patients. However, lack of proper recognition and understanding of stress-related disorders has rendered optimal assessment and treatment elusive. Ample evidence has demonstrated an association between chronic stress exposure and the development of chronic diseases. Ironically, only a small percentage of clinicians understand how dysfunction within the stress management system (HPA axis) alters pathophysiology. To further muddy the waters, the use of simplified terms such as “Adrenal Fatigue” have widened the gap of knowledge by leading many to discredit the very real pathophysiological consequences of HPA axis dysfunction. This paper will provide an evidence based overview of the metabolic and clinical sequelae of stress-induced HPA axis dysfunction manifesting as hypocortisolism, the state of abnormally low daytime cortisol.