Unlike many medical conditions that have an insurance code attached to them. Many medical conditions have an insurance code attached to them. This means they also have a standard prescription etched next to their name in the Physician’s Desk Reference. Adrenal fatigue has neither.

This results in some inconsistency between many recommendations, especially those found online. Whilst this does not necessarily meant that conflicting opinions are wrong, only that some recommendations may be more suitable than others depending on individual circumstances. Understanding the basis for different approaches is important in evaluating what you read. A large gulf exists between one camp that recommends adrenal extracts, and those that maintain that hydrocortisone is the better option. Both have their uses in the treatment of adrenal fatigue.

Hydrocortisone is perhaps the most direct approach. Hydrocortisone is bioidentical to cortisol, so oral supplementation has a very reliable and measured effect on boosting low cortisol levels into a healthy range. It takes a daily dose of 5-20mg to achieve this, and many find that their symptoms recede quite rapidly upon the administration of the tablets. However, this comes at a cost; just as when athletes use anabolic steroid hormones, the internal balance of the body and the endocrine glands may be disturbed through the inhibition of negative feedback loops and pituitary production of ACTH. In essence, whereas the adrenal glands normally receive a regular signal from the brain requesting the production of hormones like cortisol, the introduction of exogenous hormones means that circulating levels of cortisol are high enough and the brain no longer sends such a signal. Adrenal atrophy (shrinkage) and dependency can occur.

It is these side effects that cause such damning indictment of the hydrocortisone approach. Those that criticise point to the benefits offered by adrenal extracts. Adrenal extracts have been used since the beginning of the 20th century and, whilst containing no significant traces of hormones, contain a rich array of nucleic acids, enzymes and fatty acids unique to the adrenal glands. They help nourish the adrenal glands and restore hormonal production without interrupting the complicated feedback systems of the hypothalamic-pituitary-adrenal axis. The value of extracts is not disputed, although the effect is not always instant and some individuals will not respond well to use of adrenal extracts. The individual’s response should be measured and treatment tailored accordingly.

For those that do not get on well with increased vitamin support, adrenal extracts or licorice root, the simple (if somewhat blunt) solution of providing steroid replacement with hydrocortisone tablets remains a solution to stabilise the function of other organ systems that rely upon a suitable output of cortisol. Used for short periods of time, atrophy need not occur.

The treatment for adrenal fatigue is often as varied as the symptoms suffered by an individual. When one considers the varied requirements for pantothenic acid and vitamin C, it becomes obvious that people would be likely to respond differently to interventions like adrenal extracts or hydrocortisone. A practitioner must let the body’s responses guide them in their decisions on how to use the extracts, and the pros and cons of steroid replacement should be carefully considered before use of hydrocortisone. Undoubtedly, both have a significant role to play in adrenal fatigue, but that exact role will vary from one person to the next.

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