Fatigue

Fatigue is a common symptom in many endocrine disorders. It is also a symptom for a large number of conditions. We are not a fatigue clinic or specialists for this, but it will be addressed in context of established hormonal dysfunction.


fatigue
Adrenal Fatigue is an imaginary condition made-up by practitioners who generally are selling some type of supplement or vitamin. 
“Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms. Adrenal insufficiency is a real disease diagnosed through blood tests. There is no test that can detect adrenal fatigue because it does not exist. Supplements and vitamins given to “treat” adrenal fatigue may not be safe. Take these supplements at your own risk as some of them can cause your adrenal glands to stop working and may put your life in danger.  Adrenal insufficiency is a real medical condition that occurs when our adrenal glands cannot produce enough hormones. Adrenal insufficiency is caused by damage to the adrenal glands or a problem with the pituitary gland.  A person with adrenal insufficiency may be dehydrated, confused, or losing weight. He or she may feel weak, tired, or dizzy, and have low blood pressure. Other symptoms include stomach pain, nausea, vomiting, and diarrhea. Adrenal insufficiency is diagnosed through blood tests, and can be treated with medications that replace the hormones the adrenals would normally make.
Adrenal fatigue has been promoted by integrative medicine and naturopathic medicine for many years based on salivary cortisol day curves. These particular practitioners employ intentionally arbitrary and very narrow reference ranges for these salivary day curves, so that most patients will have at least one measurement outside of this so-called “normal” range. The idea that chronic stress “physical or psychological” may somehow down regulate the HPA axis is not supported by any good clinical science. In fact, the contrary is true. Patients with chronic fatigue syndrome have not been shown to have any consistent dysregulation of pituitary-adrenal function, and well-designed randomized controlled trials assessing the use of hydrocortisone in these patients have shown only short-term benefit. In addition, patients with post-traumatic stress disorder may have basal cortisol levels slightly lower than healthy subjects, but there is clearly a hyper-responsiveness of the HPA axis during periods of stress, and this heightened sympatho-adrenal response may contribute to dysphoria and rage seen in some of these patients.


Key Points: Fatigue from an endocrine context 

1. Our physicians cannot address your fatigue unless it is due to an objective endocrine cause. 
2. There is no such diagnosis as "adrenal fatigue" and there is no test for it. Our physicians do not treat this issue.
3. Wilson’s syndrome is a supposed thyroid hormone deficiency that is not supported by science. Our physicians will not address this issue. 
4. Fatigue is a broad topic and we recommend a common-sense approach as written here.  Our physicians are not fatigue specialists. 

Sluggishness, reduced concentration, body aches --- many people have these symptoms from time to time. If they persist or grow severe, patients want immediate relief. With thousands of accepted medical diagnoses, however, pinpointing the precise cause of your problems can be a challenge. One umbrella diagnosis suggested for literally dozens of common ailments from fatigue, to depression, to headaches, is “Wilson’s Temperature Syndrome.” This syndrome is not to be confused with Wilson’s disease—a medically recognized condition caused by a defect in copper metabolism. Wilson’s syndrome—a supposed thyroid hormone deficiency that is not supported by science—describes common symptoms that many people experience. Hypothyroidism is a true medical condition that requires treatment.  Hashimoto's without hypothyroidism does not have an established treatment or medication, so click this link to learn more about our clinic's approach to Hashimoto's. Some of these symptoms may be due to serious medical problems that can be treated successfully, but require prompt medical attention. Pursuing hormone therapy for Wilson’s Syndrome might distract patients from seeking a proper diagnosis of a treatable medical condition. 

Testosterone levels in men drop, on average, 1% per year after age 30.  Sperm production does not stop. The term “menopause” only pertains to the females when the ability to reproduce is stopped. Testosterone is the male sex hormone that is needed for growth of body hair, building strong bones and muscles, and producing sperm. As men age, testosterone levels (T-levels) can decline because of medication, illness, injury or lifestyle factors. This drop in testosterone is incorrectly classified as “male menopause,” when in fact, should simply be considered a symptom of male aging, more clinically referred to as testosterone deficiency syndromeandrogen deficiency of the aging male, and late-onset hypogonadism.  You may have seen the ads for over-the-counter supplements to help men with “low-T” (low testosterone), but do you really need them?  No. There are ways for aging men to help naturally maintain health:  eat a healthy diet, maintain a healthy weight.

Low testosterone in women is associated with reduced libido in some studies.  Low testosterone levels in women are expected after menopause and is a normal laboratory phenomenon. Treatment with testosterone creams or pellets or injections is not mandatory. Our clinic does not treat low testosterone in women. 

A common sense approach to fatigue. If you feel tired, weak, or depressed you can request your doctor look for treatable diagnoses such as may have adrenal insufficiency, hypothyroidism, depression, obstructive sleep apnea, or other health problems. We do encourage all patients to make sure they get at least 7-8 hours of continuous uninterrupted sleep per night. Insomnia leading to less than 7-8 hours of CONTINUOUS UNINTERRUPTED SLEEP can lead to almost all the same subjective symptoms of hypothyroidism including weigh gain and "brain fog".   Sleep apnea causes un-noticed interrupted sleep and must be evaluated by a sleep study with a sleep specialist. Insomnia (inability to fall asleep or stay asleep) is a common cause of interrupted sleep but a patient may not realize the impact on quality of life. If insomnia is a problem we recommend cognitive behavioral therapy for this issue and we can recommend several practitioners for this issue. The non-specific symptoms of sleep deprivation or poor sleep quality can be very similar to those of adrenal insufficiency or hypothyroidism. 


Endocrinologists can only search for clear hormonal causes for fatigue and try to rule those in or out. In general we recommend patients to: Maintain a normal weight. Get plenty of exercise,  Get enough sleep. Meditate daily (mindfulness). Find healthy ways to cope with stress. 

Causes of chronic fatigue listed by category and subcause-
PSYCHOLOGIC
Depression
Anxiety
Somatization disorder
Malnutrition or drug addiction

PHARMACOLOGIC
Hypnotics
Antihypertensives
Antidepressants
Drug abuse and drug withdrawal

ENDOCRINE-METABOLIC
Hypothyroidism
Diabetes mellitus
Apathetic hyperthyroidism
Pituitary insufficiency
Hypercalcemia
Adrenal insufficiency
Chronic renal failure
Hepatic failure

NEOPLASTIC-HEMATOLOGIC
Occult malignancy
Severe anemia
INFECTIOUS 
Endocarditis
Tuberculosis
Mononucleosis
Hepatitis
Parasitic disease
HIV infection
Cytomegalovirus

CARDIOPULMONARY
Chronic heart failure
Chronic obstructive pulmonary disease

CONNECTIVE TISSUE DISEASE
Rheumatoid disease

DISTURBED SLEEP
Sleep apnea
Esophageal reflux
Allergic rhinitis
Psychologic causes (see above)

IDOPATHIC (diagnosis by exclusion of above causes)
Idiopathic chronic fatigue
Chronic fatigue syndrome
Fibromyalgia

References
Adrenal insufficiency, Subclinical and Adrenal Fatigue. Richard J. Auchus , MD, PhD1 and James W. Findling , MD2
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