As National Stress Awareness Day is upon us, the question is: why is the term adrenal fatigue still controversial in the mainstream medical community?
Most Drs widely accept that when the body is exposed to stress, a complex counter regulatory "adaptive stress response" occurs that comprises the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. Excessive, prolonged or inadequate regulation of the stress response system is linked to a number of diseases.
Knowing this, why is adrenal fatigue controversial? I think the reason comes down to the imperfect nomenclature and the medical community's focus on organ based disease rather than disease process.
From a linguistic point of view, the problem with the term adrenal fatigue is that it puts stress-related disease into the unilateral remit of the adrenal glands, which its not! A number of things (growth hormone, corticotrophin releasing hormone, insulin to name a few) can contribute to problems with cortisol. Just as we talk about low insulin rather than pancreatic fatigue when it comes to type 1 diabetes, so too would it be better to talk about low cortisol rather than adrenal fatigue. By using the term "adrenal fatigue" we are implying that we should be able to see some pathology in the adrenal gland which we cant: that's why black and white thinkers will readily accept the diagnosis of Addison's disease (which IS pathology in the adrenal gland) but ignore adrenal fatigue (which has some overlapping symptoms, because the underlying problem of low cortisol is the same, just to a lesser degree).
One of the biggest problems about how we diagnose things currently is that we like to link diseases to organs and then refer to the Dr that specializes in that organ. Well imbalances and dysfunctions aren't linked to one organ! A single disease process can affect many things and be affected by many other processes! We need to start also talking in terms of disease processes such as insulin resistance, oxidative stress, inflammation to name a few.
So whilst I'm pleased that the term adrenal fatigue has drawn much popular attention to stress related disease, I also recognize that the simplistic nature of this term allows literal thinkers to criticize the concept, and moreover underestimates the complexity of the stress-response system.
But we shouldn't let the limits of our language be the limits of our world. Call it what you want, but don't stop talking about it! Because however daunting it might be to try to work out how hypocortisolism has arisen in a particular individual, it is a real phenomenon linked with chronic pain, chornic fatigue, impaired thinking and poorer immunity, and clinicians who understand the complexity of the HPA axis will succeed where others may fail.