While adrenal fatigue may not exist, this doesn’t mean the symptoms people experience aren’t real. These same symptoms could be caused by true medical conditions such as sleep apnea, adrenal insufficiency, or depression. Accepting a fake disease diagnosis from an unqualified practitioner is arguably worse. Patients don’t receive a science-based evaluation of their symptoms, and they may be sold unnecessary treatments that are probably ineffective and potentially harmful. The Endocrine Society’s guidance is entirely appropriate:
It is often frustratingly hard to find and maintain an effective course of treatment. This area demands new solutions. One of the primary concerns for someone with AI is a sudden or severe drop in their level of cortisol. The body produces cortisol to respond to stress. Cortisol is also important in maintaining blood pressure and cardiovascular function, slowing the immune system’s inflammatory response, balancing the effects of insulin in breaking down sugar for energy and regulating the metabolism of proteins, carbohydrates and fats. Because of this, a significant drop in cortisol can have serious and life-threatening effects on the body. This drop is referred to as an adrenal crisis and a person with AI must keep a close watch on their body and its functioning at all times in order to prevent this type of medical emergency.
Catecholamines are produced in chromaffin cells in the medulla of the adrenal gland, from tyrosine , a non-essential amino acid derived from food or produced from phenylalanine in the liver. The enzyme tyrosine hydroxylase converts tyrosine to L-DOPA in the first step of catecholamine synthesis. L-DOPA is then converted to dopamine before it can be turned into noradrenaline. In the cytosol , noradrenaline is converted to epinephrine by the enzyme phenylethanolamine N-methyltransferase (PNMT) and stored in granules. Glucocorticoids produced in the adrenal cortex stimulate the synthesis of catecholamines by increasing the levels of tyrosine hydroxylase and PNMT.