Adrenal Fatigue, Adrenal Exhaustion and the Thyroid

Shot of a tired young woman sitting on the floor leaning against her bed

Integrative and holistic physicians believe that if you have a thyroid condition, you are at higher risk of a problem known as adrenal exhaustion, adrenal fatigue, or adrenal insufficiency. These types of adrenal issues are controversial, however, and there is a great deal of debate about whether adrenal fatigue is a valid diagnosis. Let's take a look at the concept of adrenal fatigue and exhaustion.

About Your Adrenal Glands

Your two adrenal glands are small, triangular-shaped endocrine glands located on the top of each of your kidneys. Each adrenal gland is approximately 3 inches wide, and a half-inch high.

Each adrenal gland is divided into an outer cortex and an inner medulla. The cortex and medulla of your adrenal gland secrete different hormones. The adrenal cortex is essential to life, but the medulla may be removed with no life-threatening effects.

Hormones of Your Adrenal Cortex

Your adrenal cortex consists of three different regions, with each region producing a different group or type of hormones. Chemically, all the hormones produced by your cortex are considered steroids.

Mineralocorticoids are secreted by the outermost region of the adrenal cortex. The principal mineralocorticoid is aldosterone, which acts to conserve sodium and water in your body.

Glucocorticoids are secreted by the middle region of the adrenal cortex.

The principal glucocorticoid is cortisol, which increases blood glucose levels. Chronic excessive levels of cortisol are seen in an autoimmune condition known as Cushing's syndrome. And chronically low, and insufficient levels of cortisol are seen in another autoimmune condition called Addison's disease.


The third group of steroids secreted by the adrenal cortex is the gonadocorticoids, or sex hormones. These are secreted by the innermost region. While the testes and ovaries are the primary producers of sex hormones, the adrenal cortex releases male hormones like testosterone, and female hormones such as estrogens, in minimal amounts.

Hormones of Your Adrenal Medulla

Your adrenal medulla secretes two hormones, epinephrine and norepinephrine. These two "fight-or-flight" hormones are released in response to stressful physical and emotional situations. 

Do You Have Adrenal Fatigue? The Symptoms of Adrenal Fatigue

Integrative physicians believe that some people suffer from fatigue of the adrenal glands. They believe that your adrenals become less effective at staying balanced and producing enough hormone after periods of intense or lengthy physical or emotional stress.

Some other names for the syndrome include non-Addison's hypoadrenia, sub-clinical hypoadrenia, hypoadrenalism, and neurasthenia.

The symptoms of adrenal fatigue include:

  • excessive fatigue and exhaustion
  • non-refreshing sleep (you get enough hours of sleep, but wake feeling fatigued)
  • feeling overwhelmed by or unable to cope with stress
  • feeling rundown or overwhelmed
  • craving salty and sweet foods
  • feeling most energetic in the evening
  • having low stamina, slow to recover from exercise
  • recovering slowly from injury, illness or stress
  • difficulty concentrating, brain fog
  • poor digestion
  • low immune function
  • food or environmental allergies
  • premenstrual syndrome or difficulties that develop during menopause
  • consistent low blood pressure
  • extreme sensitivity to cold

The adrenals produce hormones that help to balance your blood sugar, which helps your body to manage your daily ebbs and flows of energy. When blood sugar drops, the adrenals release hormones that cause the blood sugar to rise and increase your energy.

The adrenals also release hormones when you're under stress, releasing energy. That "fight or flight" response can activate for any type of stress, including lack of sleep, financial worries, work pressures, family challenges, arguments, traffic, illness, surgery, and poor nutrition. 

The Controversy

Integrative physicians believe that being consistently under stress can take a toll on your adrenal glands, and eventually, they stop producing sufficient hormones.

The concept of adrenal fatigue is controversial, however. Many conventional physicians and endocrinologists do not acknowledge adrenal dysfunction unless it is extreme, such as a complete lack of adrenal function in Addison's disease, or the excessive production of adrenal hormone seen in Cushing's disease.

An integrative or complementary practitioner, however, can do a 24-hour saliva cortisol/DHEA test to evaluate your adrenal function, and diagnose more subtle dysfunctions in your adrenal glands.

Solutions for Adrenal Fatigue

If you are suffering from adrenal fatigue, what can you do? Here are a few tips that can help.

  • Get Enough Sleep: Sleep is an important part of helping to manage stress response and stress hormones. You should aim for 7 or more hours per night of quality sleep. 
  • Avoid Stimulants: As much as you may want them, stimulants are the equivalent of giving too much gas and "flooding the engine" in a car. It puts further stress on your adrenals to work harder and produce more energy, and ends up further depleting your adrenal glands. Things to avoid include: caffeine, ephedra, guarana, kola nut, and prescription stimulants.
  • Balance Your Blood Sugar With Your Diet: To minimize stress on your adrenals and ensure maximum energy, you should consider a low-glycemic (low-sugar) diet, consisting of sufficient protein, fat, and low-glycemic carbohydrates. Sugar and simple carbohydrates put stress on the adrenal glands due by rapidly shifting blood sugar levels. By switching to vegetables and proteins, blood sugar remains more stable, providing less strain on the adrenal glands.
  • Use Adaptogenic Herbs: Some of the herbs and supplements that are used by integrative practitioners include the ayurvedic remedy ashwagandha, ginseng, and higher-dose vitamin C.

Other helpful supplements include: 

  • Adrenal Glandulars: Desiccated adrenal gland can be helpful to some people in supporting the gland, and replacing some missing adrenal hormones. Be sure to get a reputable brand from a reputable supplier, to ensure quality, potency and safety. These should only be taken under the guidance of a practitioner.
  • Pregnenolone, DHEA: Pregnenolone and DHEA are hormones that can help resolve adrenal fatigue. You should be tested for these hormones before supplementation, however, and use of these over-the-counter hormones is recommended only under the guidance of your practitioner.

If you have significant adrenal fatigue that doesn't respond to supplements or lifestyle changes, you may benefit from low-dose prescription hydrocortisone treatment. You will need a more open-minded, aware doctor to obtain this sort of treatment. Consider finding an integrative physician with expertise in diagnosing adrenal fatigue, providing supplement, nutrition and lifestyle support, who will prescribe hydrocortisone when necessary.

A Word from Verywell

This is by no means a comprehensive list of supplements or solutions. You may also want to read Dr. Robin Berzin's 9 Steps To Heal Adrenal Fatigue Naturally. Remember, however, that diagnosing and treating adrenal fatigue is never a do-it-yourself project. Your most effective approach will be to work with a knowledgeable health care provider who can develop a customized treatment program that will help you get your adrenal health back on track.


Edwards, MD Lena, et. al. "Beyond Adrenal Fatigue: From Anecdotal to Evidence Based Medicine." The American Academy of Anti-Aging Medicine. 2015. 

Khalsa, Karta Purkh Singh, Tierra, Michael. "The Way of Ayurvedic Herbs: A Contemporary Introduction and Useful Manual for the World's Oldest Healing System," Lotus Press. 2008

Melmed S, et. al. "Williams Textbook of Endocrinology. 12th ed." Philadelphia, PA: Elsevier Saunders; 2011

Newman, Tim. "Adrenal Fatigue: Does It Exist? What Is Adrenal Insufficiency?" Medical News Today. 3 February 2016

Wisse, Brent, MD. "Adrenal Glands." MedlinePlus, U.S. National Library of Medicine.