Adrenal Fatigue - a Real Disorder

[Guest guest]

Adrenal Fatigue—A Real

Disorder

No Matter What its Name:

A Response to Dr. Hibberd

Dr. C. Lowe

http://www.drlowe.com/emailnewsletter/2009archive3.htm

Yesterday afternoon, I was

working to finish a newsletter that contained an article I've written on

thyroid antibodies. I knew that many of our readers would find the topic

interesting and helpful. But then something happened that abruptly stopped the

press. A friend sent me a copy of Dr. Hibberd's latest newsletter.

Hibberd's newsletter contains an inquiry from someone named Jim Z: " Please

explain, " Jim asks Dr. Hibberd, " what causes adrenal fatigue, how to

treat it, and how long it takes to recover. " When I read Dr. Hibberd's

answer, I put away the antibody article and wrote this response to his answer

to Jim. Below, I address each part of Hibberd's one paragraph answer.

Terms Physicians Use. In answering

Jim, Dr. Hibberd first wrote, " Adrenal fatigue is not a term physicians

use. " This statement is less important than the others Hibberd made, but

as it is categorically false, it needs correcting.

Dr. , author of Adrenal

Fatigue,[7] is a PhD, and he's also a

chiropractic and naturopathic physician. If no other physician in the world

uses the term adrenal fatigue, Dr. certainly does, and that fact alone

refutes Hibberd's absolutistic pronouncement. Hibberd, of course, may not

consider chiropractic and naturopathic doctors physicians. (Labs and insurance

companies classify them as physicians, and many states in the U.S. license them

as such. But this is a quibble, so I'll move on.)

Even if Hibberd doesn't consider Dr. a physician, Hibberd's statement is

still patently false. I've attended lectures by Dr. on adrenal fatigue

in which he addressed audiences of up to 700 clinicians; most of them were MDs

and DOs. Also, Dr. often lectures across the nation to other groups of

physicians. And he isn't the only physician who teaches other physicians to

diagnose and treat adrenal fatigue. The total number of physicians who have

studied under Dr. and other believers-in-adrenal-fatigue is assuredly

large, and I'm confident that most of them do use the term adrenal fatigue.

I've personally talked with scores of physicians specifically about the

disorder, and we all have conversed using the term Dr. Hibberd denies

physicians use.

Many conventional physicians, including endocrinologists, often discuss health

problems related to low levels of cortisol. It's true that when they do, most

use older terms such as " hypoadrenalism, " " adrenal

hypofunction, " and most often, " adrenal insufficiency. " These

terms, of course, are only synonyms for the newer term, " adrenal

fatigue. " But as you'll see, Dr. Hibberd even questions the existence of

what conventional physicians call adrenal insufficiency.

Symptoms from Low Cortisol. Dr. Hibberd went on to say to Jim, " It

[adrenal fatigue] is popular with alternative medical publications and is used

to describe vague symptoms of fatigue, irritability, and body aches allegedly

arising from adrenal insufficiency. " (Italics mine.)

Here, Hibberd appears to question that such symptoms arise from adrenal

insufficiency. I say this because he refers to the association between the

symptoms and adrenal insufficiency as alleged. This means, of course, that

alternative clinicians assert the association between the symptoms and the

disorder with no proof of it.

Some clinicians do use the term adrenal fatigue to refer to patterns of

symptoms. I certainly do. I do so because it's well documented that patients

with too little adrenal production of cortisol experience the symptoms.

Descriptions of the symptoms extend back at least 100 years in medical

textbooks. Today, one can quickly find descriptions of the same symptoms

through search engines on the Internet and at PubMed. Hibberd can also go to any

medical library, and there, he'll find scores of recent textbooks on diagnosis

that describe these same symptoms " arising from 'adrenal

insufficiency.' " Many such books describe the symptoms of different

degrees of adrenal insufficiency. They describe the symptoms of severe adrenal

insufficiency including the potentially-deadly shock of adrenal crisis. But

they also describe milder symptoms from less severe cortisol deficiencies.

After Taber's Medical Dictionary,[5,p.40] we can refer to the latter as " relative "

adrenal insufficiency, meaning relative to reference-range levels of cortisol.

As any other physician does, Dr. Hibberd needs to learn the symptoms of adrenal

fatigue, adrenal insufficiency, or whatever one prefers to call it. He can do

so within less than five minutes by Googling the two terms " adrenal

insufficiency and symptoms. " A huge number of medically-related websites

will come up. When I did this a few minutes ago, Google gave me a count of

sites that contain the two terms. The number was 251,000. When I typed in

" symptoms and adrenal fatigue, " Google indicated that 218,000

websites contain the terms.

When I used " adrenal fatigue " as the search term in PubMed, 919

abstracts of published papers came up. And when I used " adrenal

insufficiency " as the search term, the number of abstracts that came up

was 11,980. That's a lot of publications about a medical disorder that

supposedly doesn't exist. Hundreds of the papers indexed in PubMed—far

too many to reference here—resoundingly refute Hibberd's claim

that " . . . tests used to define a decrease in adrenal function known [sic]

do not support the existence of the condition.

The first paper indexed by PubMed that mentions adrenal insufficiency is dated

1922. It was published in the Journal of Physiology.[14] Its title is, " On the

concentration of the blood and the effects of histamine in adrenal

insufficiency. " Hibberd implies that the term adrenal insufficiency is

used only in " alternative medicine publications. " The Journal of

Physiology, however, is not an alternative medicine publication. Nor are

scores of other journals that have published hundreds of papers on the

condition Hibberd calls " allegedly " adrenal insufficiency. Consider

one, the French medical journal La Presse Medicale. In 1953, it

published a paper[6] about a symptom Hibberd seems to

doubt can result from adrenal fatigue. The paper's title is, " Fatigue; a

functional adrenal insufficiency syndrome. " Hibberd can easily confirm

that La Presse Medicale is far from an alternative publication; it's

about as conventional as medical journals get.

Learning through Personal Experience. For some physicians, published scientific

evidence is not good enough. They believe only what they themselves personally

experience. If this is true for Dr. Hibberd, I suggest that he test through

personal experience whether or not symptoms result from adrenal insufficiency.

He can do this by undergoing a modified metyrapone test.

Metyrapone has long been used by endocrinologists to diagnose the adrenal condition

that Hibberd denies exists. Diagnosticians even use the drug to differentiate

between two well-known forms of adrenal insufficiency.[3][4] The drug lowers cortisol levels by

preventing the last step in the production of cortisol. It does so by blocking

the enzyme 11beta-hydroxylase that triggers the conversion of 11-deoxycortisol

to cortisol.[4,pp.278-9]

I challenge Dr. Hibberd to use metyrapone to lower his cortisol level by, say, 40%,

and keep it there for a week while he works the most demanding hours in the ER.

If he then comes back and tells us with a straight face that symptoms such as

fatigue don't develop from low cortisol levels (as in adrenal fatigue), I may

start to doubt my own sanity. Instead, though, I'm confident that he'll come

back a physician newly enlightened about the fact of adrenal fatigue.

But taking the drug metyrapone isn't the only way to induce adrenal

insufficiency. Stress can also do it, as Dr.

explains so well.[7] In fact, stress is basic to the

concept of adrenal fatigue. Studies have shown that patients who have had

chronic stress, sometimes resulting in post-traumatic-stress-disorder, have low

urinary and blood cortisol levels.[8][9]

In one study, the more combat experience veterans had, the lower their blood

levels of cortisol.[10] Researchers found that women with

chronic pelvic pain had lower blood and saliva levels of cortisol. The

researchers conjectured that the women's pain resulted from too little

protective cortisol. They reported that the women's low cortisol was

associated with more abusive experiences and a higher number of " major

life events. " [11] And low cortisol levels have

followed the stress of recent myocardial infarctions.[12]

Conclusions.

Dr. Hibberd concluded: " Be careful accepting diagnostic labels from an

unqualified individual. Instead, consult your personal physician for [sic]

correct diagnosis. Your recovery time will depend upon treatment options

provided once your real diagnosis has been established. "

When it comes to diagnosing and treating the well-documented disorder of

adrenal insufficiency, who is the " unqualified individual " (to use Hibberd's

term)? In my opinion, one such person is the clinician who is unaware that the

disorder exists. This clinician is not likely to order tests that can verify

that the disorder is the cause of a patient's symptoms. In that case, the

patient's " recovery time " (to use another of Hibberd's terms) will be

delayed until he finds another clinician who'll accurately diagnose the

disorder and properly treat the patient for it.

Unfortunately, the delay can compound the patient's woes. Consider, for

example, the patient with antibodies against the cortex of his adrenal glands.

These can cause the form of adrenal insufficiency called " 's

disease. " Classic symptoms of the disorder are weakness and fatigue that

clinicians used to call " asthenia. " The antibodies lower cortisol

levels by destroying an enzyme, 12-hydroxylase, that converts a form of

progesterone to cortisol. If a physician is aware that low cortisol could be

the cause of his patient's fatigue, he's likely to order appropriate tests.

These can confirm both the low cortisol and the autoimmune process. With proper

treatment, the cost to the patient's health can be limited to the fatigue he

suffered before proper treatment began.

But consider what can happen if the physician falsely believes that low

cortisol from adrenal insufficiency doesn't occur and doesn't cause fatigue. He

may fail to confirm through testing the cause of the patient's fatigue. Then,

as precious time passes, the inflammatory process in the patient's adrenal

glands may progress, and he may end up with widespread destruction of the

cortex of the glands. This will result in deficiencies of other hormones in

addition to cortisol.[13] In this happens, the cost to the

patient's health will far exceed his experience of fatigue.

To believe that adrenal insufficiency doesn't exist is about like believing

there is no such condition called anemia. The fact is, Dr. Hibberd is as likely

to encounter patients with adrenal fatigue as he is those with anemia. I trust

that he wants to serve all his patients well. So that he can—including

those with adrenal fatigue—I urge him to correct his false beliefs about

the disorder (even if he refuses to call it by the new term), and to learn how

to diagnose and treat it so he can help those countless people whose symptoms

are caused by it.

References

1. Ask

Dr. Hibberd: NewsMax.com, 4152 West Blue Heron Blvd, Ste 1114, Riviera Beach,

FL, 33404 USA, April 08, 2009.

2. Dolman, L.I., Nolan, G., and Jubiz, W.: Metyrapone test with

adrenocorticotrophic levels. Separating primary from secondary adrenal

insufficiency. JAMA, 241(12):1251-1253, 1979.

3. Berneis et al.: Combined Stimulation of Adrenocorticotropin and Compound-S

by Single Dose Metyrapone Test as an Outpatient Procedure to Assess

Hypothalamic-Pituitary-Adrenal Function. J. Clin. Endocrinol. Metab., 87:5470-5475,

2002.

4. Stobo, J.D., Hellmann, D.B., Ladenson, P.W., et al.: The Principles and

Practice of Medicine, 23 edition. New York, McGraw-Hill Professional, 1996.

5. Taber's Cyclopedic Medical Dictionary. Edited by C.L. .

Philadelphia, F.A. Co., 1985.

6. Rivoire, M.R., Rivoire, J., and Poujol, M.J.: Fatigue; a functional adrenal

insufficiency syndrome. Presse Med., 61(70):1431-1433, 1953.

7. , J.L.: Adrenal

Fatigue: The 21st Century Stress Syndrome. Petaluma, Smart

Publications, 2005.

8. Yehuda, R.: Biology of posttraumatic stress disorder. J. Clin. Psychiatry,

Suppl 17:41-46, 2001.

9. Kanter, E.D., Wilkinson, C.W., Radant, A.D., et al.: Glucocorticoid feedback

sensitivity and adrenocortical responsiveness in posttraumatic stress disorder.

Biol. Psychiatry, 50(4):238-245, 2001.

10. Boscarino, J.A.: Posttraumatic stress disorder, exposure to combat, and

lower plasma cortisol among Vietnam veterans: findings and clinical

implications. J. Consult. Clin. Psychol., 64(1):191-201, 1996.

11. Heim, C., Ehlert, U., Hanker, J.P., et al.: Abuse-related posttraumatic

stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in

women with chronic pelvic pain. Psychosom. Med., 60(3):309-318, 1998.

12. Ceremuzyñski, L., Kuch, J., Markiewicz, L., et al.: Patterns of endocrine

reactivity in patients with recent myocardial infarction. Clinical and

biochemical correlations: trial of endocrine therapy. Br. Heart J.,

32(5):603-610, 1970.

13. Winqvist, O., Rorsman, F., and Kämpe, O.: Autoimmune adrenal insufficiency:

recognition and management. BioDrugs, 13(2):107-114, 2000.

14. Kellaway, C.H. and Cowell, S.J.: On the concentration of the blood and the

effects of histamine in adrenal insufficiency. J. Physiol.,

57(1-2):82-99, 1922.