Low Adrenal Function / Adrenal Insufficiency

The adrenal glands, located above the kidney, often become ‘exhausted’ as a result of the constant demands placed upon them. An individual with adrenal exhaustion will usually suffer from chronic fatigue, may complain of feeling stressed-out or anxious, and will typically have a reduced resistance to allergies and infection.

The adrenal glands secrete several important hormones that help maintain the balance of many body functions. Stress, fasting, temperature changes, infections, drugs, and exercise all stimulate the adrenals to release their hormones. When the adrenals release too few or too many hormones, the body responds differently to the everyday stresses of life.

The adrenal cortex is involved in the production of glucocorticoids (such as cortisol i.e. hydrocortisone), mineralocorticoids (aldosterone) and androgens such as androstenedione and DHEA. A mild to moderate adrenocortical deficiency can substantially reduce your quality of life, yet this condition is not recognized by most doctors, who only think of the adrenal gland’s condition as being at either extreme – normal or in overt failure (Addison’s disease).

For the large number of people in between, physiologic replacement doses of oral cortisol can make a dramatic difference. Because of side effects induced by larger doses, many doctors are reluctant to use it and many patients are thus deprived of a valuable and needed therapy. Physiologic doses of cortisol (5-25mg per day) are safe. Lab testing can confirm the diagnosis of mild adrenocortical deficiency. A doctor experienced with cortisol use should be consulted; a typical prescription is 5mg four times per day, with an emphasis on early morning use if later doses keep you up at night, or if fewer doses are taken.

For those concerned about taking a hormone perhaps for life, a more natural approach to strengthening the adrenal gland can be tried. This may include vitamin C, PABA, adrenal glandulars, ACE (Adreno-Cortico-Extracts) injections, licorice root, ginsengs, TMG (tri-methyl-glycine) and DHEA among other possibilities.


Signs, symptoms & indicators of Low Adrenal Function / Adrenal Insufficiency

Lab Values - Common  

Low systolic blood pressure


Low diastolic blood pressure

Symptoms - Aging  

Loss of interest in activities

Symptoms - Allergy  

Allergies to certain foods

Symptoms - Environment  

Poor tolerance of cold


Poor tolerance of heat

Symptoms - Female  

Enlarged clitoris


Male characteristics

Symptoms - Food - Beverages  

Frequent/constant thirst

Symptoms - Food - General  

Weak appetite

Symptoms - Food - Preferences  

Craving for salt

Symptoms - Gas-Int - General  

Meal-related bloating

Symptoms - General  

Fatigue that worsens during the day


Major fatigue for over 12/minor fatigue for over 3/major fatigue for over 3 months


Constant fatigue


Fatigue on light exertion


Slow recovery from colds


Dizziness when standing up

Counter Indicators
Symptoms - General  

No fatigue on light exertion


Chronic fatigue now resolved


Absence of worsening fatigue


(No) history of fatigability

Symptoms - Hair  

Balding lower legs

Symptoms - Head - Eyes/Ocular  

(High) sensitivity to bright light


Vision disturbances

Symptoms - Head - Nose  

Allergic rhinitis

Symptoms - Immune System  

History of infections


Postviral syndrome

Symptoms - Metabolic  

Low stamina


Low body temperature


Frequent colds/flus


Being severely affected by flus

Counter Indicators
Symptoms - Metabolic  

High stamina

Symptoms - Mind - Emotional  

Adverse reaction to stress


Inability to work under pressure


History of depression


Occasional/frequent emotional exhaustion

Symptoms - Muscular  

Tender muscles

Symptoms - Reproductive - Female Cycle  

Hot flashes during period

Adrenal estrogen seems to be necessary to avoid hot flashes during normal menses when the ovarian production of estrogen drops. Hot flashes during menses may be a symptom of mild adrenal cortex deficiency.


Irregular menstrual cycles


Menopausal arthritis


Unexplained missed periods


Breast soreness during cycle

Symptoms - Reproductive - General  

Morning sickness


Late/probable/early miscarriage


Difficulty conceiving children

Symptoms - Respiratory  

(Frequent) sore throats

Symptoms - Skin - Conditions  

Acne worse during period

Symptoms - Skin - General  

Darker/redder skin color


Diminished perspiration


Red palms/fingertips

Symptoms - Sleep  

Difficulty getting out of bed

Conditions that suggest Low Adrenal Function / Adrenal Insufficiency



Lupus, SLE (Systemic Lupus Erythromatosis) / Risk

Lupus is one of the auto-immune diseases caused by a hyperactive (“hypervigilant”) immune system that attacks a person’s own protein as if it were foreign matter. One reason for this is poor adrenal function. Adrenal steroids modulate (slow down) the immune system: when there is not enough of these steroids the immune system goes berserk.





Counter Indicators




Low Progesterone or Estrogen Dominance

The inner most layer of an adrenal gland is the zona reticularis which produces small amounts of sex hormones. Specifically, it produces androgen, estrogen and progesterone. Adrenal exhaustion can therefore cause hormone deficiencies.



The co-existence of thyroid hormone deficiency and glucocorticoid deficiency is not rare. Primary hypothyroidism due to chronic autoimmune thyroiditis is associated with primary adrenocortical insufficiency due to autoimmune adrenalitis. The very cause of central hypothyroidism in many instances will also result in ACTH deficiency and secondary adrenocortical insufficiency. If the two entities co-exist, it is important to replace glucocorticoid before starting thyroxine. Treatment of hypothyroidism in patients with glucocorticoid deficiency may precipitate an adrenal crises because the adrenal gland is incapable to meet the increasing demand for cortisol induced by the rise of the metabolic rate.


The Immune System  

Chronic Fatigue / Fibromyalgia Syndrome

Underactive adrenals are common in CFIDS.


AIDS / Risk

Adrenal insufficiency is considerably less common than hypogonadism in people with HIV, but its incidence increases in advanced cases.


Weakened Immune System

Adrenal insufficiency can lead to a host of problems, including a weakened immune response, anxiety and panic attacks.


Lyme Disease

Hypothalamus/pituitary/adrenal axis dysfunction is frequently associated with Lyme disease, and many Lyme patients have (at least temporarily) both thyroid and adrenal insufficiency.




Chronic Inflammation

The adrenal glands produce hydrocortisol, the major natural anti-inflammatory steroid in the body. Without enough circulating cortisol there may be a tendency to become easily inflamed.

Lab Values  

Lab Values - Chemistries  

(Very) low AM saliva cortisol


(Very) low PM saliva cortisol

Counter Indicators
Lab Values - Chemistries  

Elevated PM saliva cortisol


Normal/elevated AM saliva cortisol



Unresolved Grief

Adrenal fatigue increases the time it takes to recover from illness, injury and trauma, including emotional trauma.



Adrenal insufficiency can lead to a host of problems, including a weakened immune response, anxiety and panic attacks.

Counter Indicators





Neck Pain / Problems

Observations in both animal models and humans indicate that there is an inflammatory component to cervical radiculopathy. Corticosteroids (such as dexamethasone) are potent anti-inflammatories which may benefit people suffering from this condition. Cortisone, as normally secreted from the adrenal glands, acts as an anti-inflammatory. Low cortisol levels may be associated with inflammation in the cervical spine and resultant radiculopathy.


Nervous System  

Organ Health  








Fibrocystic Breasts

[The Safe Uses of Cortisol, William Mck. Jefferies, MD 1996, p.156]



Dysmenorrhea, Painful Menstruation

Dysmenorrhea caused by ovarian dysfunction may disappear when low doses of cortisol are used to improve adrenal influence on ovarian function. [The Safe Uses of Cortisol, William Mck. Jefferies, MD 1996, p.157]


Risk factors for Low Adrenal Function / Adrenal Insufficiency


(Severe) sexual abuse during childhood

Females who have been abused are more sensitive to life’s stresses many years after the original abuse event(s). This elevated stress response can lead to adrenal exhaustion.


Rapid growth but short stature


Lab Values - Chemistries  

Low AM serum cortisol


Low pm serum cortisol


Low CO2


Elevated/low/normal 24 hr urine cortisol

Counter Indicators
Lab Values - Chemistries  

Normal/elevated AM serum cortisol


Normal/elevated pm serum cortisol or elevated serum pm cortisol

Supplements and Medications  

Antihistamine use


Prednisone use

Long-term use of prednisone can lead to adrenal suppression, possibly resulting in depression, euphoria, hypertension, nausea, anorexia, high blood sugar levels, or increased susceptibility to infection.


Using avergage dose/using low doses/using high doses of cortisol or using somewhat high doses cortisol

Counter Indicators
Supplements and Medications  

Long-term/short-term cortisol use

In many cases the continued use of low dose cortisone is necessary. With your doctors help, you can try to slowly reduce the dose to see if your own production of cortisol is sufficient to meet your needs.

Symptoms - Allergy  

History of adult allergies

Symptoms - Food - Beverages  

(High) coffee consumption

Caffeine raises adrenaline levels and heavy coffee consumption can lead to a state of adrenal gland exhaustion, where the adrenal glands are no longer able to adequately respond to stress by releasing enough adrenaline.

Symptoms - Glandular  

History of hypoglycemia


History of hyperthyroidism

Symptoms - Head - Nose  

History of sinusitis

Symptoms - Immune System  

History of postviral syndrome


History of shingles


History of chronic thyroiditis

Symptoms - Metabolic  

Recent unexplained weight loss

Weight loss can be one of the symptoms of severe adrenal weakness / failure. Symptoms of Addison’s disease are caused by a progressive loss of cortisol and aldosterone secretion from the adrenal glands.

Symptoms - Mind - Emotional  

History of postpartum depression

Symptoms - Muscular  

History of tender muscles

Symptoms - Respiratory  

History of asthma

Symptoms - Skin - Conditions  

History of adolescent acne


History of adult acne

Low Adrenal Function / Adrenal Insufficiency suggests the following may be present


The Immune System  

AIDS / Risk

Adrenal insufficiency is considerably less common than hypogonadism in people with HIV, but its incidence increases in advanced cases.

Low Adrenal Function / Adrenal Insufficiency can lead to


Lupus, SLE (Systemic Lupus Erythromatosis) / Risk

Lupus is one of the auto-immune diseases caused by a hyperactive (“hypervigilant”) immune system that attacks a person’s own protein as if it were foreign matter. One reason for this is poor adrenal function. Adrenal steroids modulate (slow down) the immune system: when there is not enough of these steroids the immune system goes berserk.

Recommendations for Low Adrenal Function / Adrenal Insufficiency




Licorice Root (Glycyrrhiza glabra)

If cortisol levels are low, one of the ways to sustain more normal levels is to slow or inhibit its breakdown. This can be accomplished naturally.

The only known readily available inhibitors of the enzyme that deactivates cortisol (11 beta-HSD) are glycyrrhizic acid (found in licorice root extract), progesterone, and flavonoids (in grapefruit). The concept of extending cortisol bioactivity via 11 beta-HSD inhibition is well established, but the manner in which progesterone alters 11 beta-HSD is not currently clear. You could eat 10 to 15 grapefruits or take licorice root extract to sustain cortisol levels. However, licorice root used regularly in large doses can produce high blood pressure, water retention, potassium wasting, and breast enlargement in men. A Naturopathic Doctor should be able to guide you in using licorice root alone or in combination with other adrenal agents.


Ginseng, Korean - Chinese / Asian (Panax ginseng)

Both Chinese ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus) are known to exert beneficial effects on adrenal function and enhance resistance to stress.

Ginseng may prove especially effective for the restoration of normal adrenal function and prevention of adrenal atrophy associated with corticosteroid administration. In rats, ginseng has been found to inhibit cortisone-induced adrenal and thymic atrophy. Ginseng could be combined with other botanicals with adrenal enhancing activity in the treatment of adrenal atrophy.


Caffeine/Coffee Avoidance

Caffeine raises adrenaline levels and heavy coffee consumption can lead to a state of adrenal gland exhaustion, where the adrenal glands are no longer able to adequately respond to stress by releasing enough adrenaline.


Conventional Drugs / Information

The use of hydrocortisol to supplement low cortisol output by weak or failing adrenal glands is essential.


Lab Tests/Rule-Outs  

Test Adrenal Function

Adrenal function can be evaluated in several ways by blood, saliva, and/or urine testing. Your doctor should know the best test to use depending on the suspected severity of the condition.


Test / Monitor Hormone levels

Although not a sex hormone, cortisol is an important hormone. A deficiency can cause fatigue with a resulting loss of sexual desire.


Increased Salt Consumption

Sea salt should be included in the diet, unless contraindicated for other reasons, as it benefits adrenal gland function. When seasoning foods, use as much salt as tastes good to you.




Reading List

In a pioneering book, The Safe Uses of Cortisol Dr. Jefferies, with 1,000 patient years of experience using cortisone therapy, explains the sources of confusion about cortisone, the significance of normal adrenocortical function and accepted uses of physiological dosages. Then he goes on to discuss using cortisone in gonadal dysfunction, rheumatic disorders, allergies and other autoimmune disorders. He closes with chapters on respiratory infections and other conditions that could benefit from physiological dosages of glucocorticoids. There may be subsequent books available at less cost, but this book was historic for me.

Adrenal Fatigue: the 21st Century Stress Syndrome by Dr. James Wilson, is a self-help lifesaver for everyone who suffers from adrenal fatigue. Adrenal Fatigue is also related to several other chronic health conditions including: frequent infections, chemical sensitivities, allergies, autoimmune diseases, fibromyalgia, rheumatoid arthritis, menopause, Hashimoto’s thyroiditis, chronic fatigue syndrome, PMS, difficult menopause, loss of libido, chronic anxiety, and mild depression.


TMG (Tri-methyl-glycine) / SAMe

The adrenal gland uses nutrients such as TMG (betaine), tyrosine, vitamins B5, B6 and C to maintain function and produce its hormones.



When midnight cortisol levels are elevated, supplementation of an additional nutrient is indicated. High midnight cortisol levels denote stress maladaptation – the loss of the negative feedback inhibition whereby the brain and pituitary gland down-regulate inappropriately elevated cortisol. Supplements of phosphatidylserine have been found to result in reduction of midnight cortisol levels. Incorporation of phosphatidylserine into the membranes of brain cells apparently restores sensitivity to cortisol receptors.


Vitamin B5 (Pantothenic Acid)

Key nutrients to aid adrenal function include vitamin C, B5 (pantothenic acid), vitamin B6, zinc, and magnesium. These nutrients not only play a critical role in the health of the adrenal gland, but also in the manufacture of adrenal hormones. Possibly the most important nutrient for the adrenal glands is pantothenic acid.



Vitamin C (Ascorbic Acid)

Taking 1-3gm of mineral ascorbates up to 3 times daily is supportive of adrenal gland function.


Vitamin Paba

PABA potentiates the hormone cortisol. When cortisol is being supplemented, the dosage of PABA may need to be reduced.


Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended


Adrenal Insufficiency

Also known as Adrenal Exhaustion or Low Adrenal Function, this is a condition where the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.

Chronic Fatigue Syndrome

CFS (Chronic Fatigue Syndrome) is a disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.


Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.


Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.


A steroid hormone secreted by the adrenal cortex that regulates the salt and water balance in the body.


Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.

Addison's Disease

Characterized by the chronic destruction of the adrenal cortex, which leads to an increased loss of sodium and water in the urine, muscle weakness and low blood pressure. The bronze color of the skin is due to the increased production of the skin pigment, melanin.


(mg): 1/1,000 of a gram by weight.

Vitamin C

Also known as ascorbic acid, Vitamin C is a water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.


(Para Aminobenzoic Acid): May be considered part of the Vitamin B complex. As a coenzyme, PABA functions in the breakdown and utilization of proteins and in the formation of red blood cells.


Tri-methyl-glycine. After supplying a methyl group, TMG becomes di-methyl-glycine. DMG, a natural component of animal and plant metabolism, positively influences the immune response in laboratory animals and humans and boosts physical and mental performance.


One of the female sex hormones produced by the ovaries.

Immune System

A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.


Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.


Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.


Any steroid hormone that increases male characteristics.


Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.


Any steroid-like compound capable of significantly influencing intermediary metabolism, such as promotion of deposition of glycogen in the liver, and of exerting a useful anti-inflammatory effect.


Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.


Usually Chronic illness: Illness extending over a long period of time.

Autoimmune Disease

One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.


The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.


Abbreviation for human immunodeficiency virus, a retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).


Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.

Panic Attack

A brief, irrational episode of fear that is perceived as so real that an individual may be driven to escape from the place or situation where it occurs. The attack is sudden and increases in severity until it leaves, usually within ten minutes. Panic attack symptoms are numerous and involve both mental and physical signs and symptoms. A panic attack can occur in other anxiety states such as agoraphobia and with certain activities and places. It may occur spontaneously without an apparent cause.


An important supervisory center in the brain regulating many body functions. Despite its importance in maintaining homeostasis, the hypothalamus in humans accounts for only 1/300 of total brain weight, and is about the size of an almond.


The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.


Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.


Difficult or painful menstruation.


High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.


Symptoms resulting from an inclination to vomit.

Anorexia Nervosa

An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.

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