“Adrenal Fatigue” is not a medical term. This has proved to be a stumbling block when speaking with doctors, many of which trot out the age-old line that ‘there is no such thing as adrenal fatigue’…  However, even if it is termed “hypocortisolism”, “hypoadrenalism” or “dysfunction of the hypothalamic-pituitary-adrenal axis”, the medical literature shows unequivocally the role of the adrenals in chronic illness. As such, nay-sayers may wish to read the studies below!


Afari N, Buchwald D (2003). Chronic fatigue syndrome: a review. Am J Psychiatry. 2003 Feb;160(2):221-36.

Arafah BM (2006). Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods. J Clin Endocrinol Metab. 2006 Oct;91(10):3725-45. Epub 2006 Aug 1.

Cleare AJ et al (2001). Hypothalamo-pituitary-adrenal axis dysfunction in chronic fatigue syndrome, and the effects of low-dose hydrocortisone therapy. 2001 Aug;86(8):3545-54.

Cleare AJ (2003). The neuroendocrinology of chronic fatigue syndrome. Endocr Rev. 2003 Apr;24(2):236-52.

Cleare AJ (2003). Glucocorticoids and glucocorticoid receptors: mediators of fatigue? Acta Neuropsychiatr. 2003 Dec;15(6):341-53. doi: 10.1046/j.1601-5215.

Cleare AJ (2004). The HPA Axis and the genesis of chronic fatigue syndrome. Trends in Endocrinology and Metabolism. Mar;15(2): 55-9.

Cleare AJ, O’Keane V, Miell JP (2004). Levels of DHEA and DHEAS and responses to CRH stimulation and hydrocortisone treatment in chronic fatigue syndrome. Psychoneuroendocrinology. 2004 Jul;29(6):724-32.

Crofford LJ (1998). The hypothalamic-pituitary-adrenal stress axis in fibromyalgia and chronic fatigue syndrome. Z Rheumatol. 1998;57 Suppl 2:67-71.

Demitrack MA, Crofford LJ (1998). Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann N Y Acad Sci. 1998 May 1;840:684-97.

Di Giorgio A et al (2005). 24-hour pituitary and adrenal hormone profiles in chronic fatigue syndrome. Psychosom Med. 2005 May-Jun;67(3):433-40.

Edwards LD, Heyman AH (2009). Adrenal dysfunction: An evidence-based review of the causes and consequences of hypocortisolism. Anti-Aging Therapeutics 2009:01:67-72.

Edwards LD, Heyman AH (2011). Hypocortisolism: An Evidence-based review. Integrative Medicine, Sep/Oct 10:4 26-33.

Gaab et al (2002). Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological, and pharmacological stimulation. Psychosom Med. 2002 Nov-Dec;64(6):951-62.

Hudson and Claere AJ (1999). The 1microg Synatchen test in chronic fatigue syndrome. Clin Endocrinology Nov;51(5):625-30.

Morris G, Anderson G, Maes M (2016).  Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways. Mol Neurobiol. 2016 Oct 20.

Parker AJ, Wessely S, Cleare AJ (2001). The neuroendocrinology of chronic fatigue syndrome and fibromyalgia. Psychol Med. 2001 Nov;31(8):1331-45.

Papadopoulos AS and Cleare AJ (2011). Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome. Nat Rev Endocrinology, Sep 27;8(1):22-32.

Straub RH, Schölmerich J, Zietz B (2000). Replacement therapy with DHEA plus corticosteroids in patients with chronic inflammatory diseases–substitutes of adrenal and sex hormones. Z Rheumatol. 2000;59 Suppl 2:II/108-18.

Tanriverdi et al (2007). The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome. Stress. 2007 Mar;10(1):13-25.

Tattersall RB (1999). Hypoadrenia or “a bit of Addison’s disease”. Med Hist. 1999 Oct; 43(4): 450–467.

Tomas C et al (2013). A Review of Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome. ISRN Neuroscience , 784520.

Van Den Eede F et al (2007). Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. Neuropsychobiology. 2007;55(2):112-20. Epub 2007 Jun 27.

Van Den Eede F (2008).  Combined dexamethasone/corticotropin-releasing factor test in chronic fatigue syndrome. Psychol Med. 2008 Jul;38(7):963-73. Epub 2007 Sep 6.

Van Houdenhove B1, Van Den Eede F, Luyten P (2009). Does hypothalamic-pituitary-adrenal axis hypofunction in chronic fatigue syndrome reflect a ‘crash’ in the stress system? Med Hypotheses. 2009 Jun;72(6):701-5. doi: 10.1016/j.mehy.2008.11.044. Epub 2009 Feb 23.  

Zarkovic et al (2003). Disorder of the adrenal gland function in chronic fatigue syndrome. Srp Arh Celok Lek, Sep-Oct; 131 (9-10); 370-4.


Websites – my own website, with articles on many areas of metabolic health – website of Dr James Wilson, a US physician who was written a book on the treatment of adrenal fatigue, which he calls ‘the 21st century stress syndrome’. – provides information and articles about a range of environmental illnesses, including adrenal fatigue.


Adrenal Fatigue: 21st Century Stress Syndrome, by Dr James Wilson

Feeling Fat, Frazzled or Fuzzy? by Dr Richard Shames