Stress: Could it be Adrenal Fatigue?


Stress has become one of the leading health problems in Western society. While most stress these days is from psychological stressors, any stressor, whether chemical, physical or psychological in origin, will provoke a physiological response in the body.

The adrenal glands, part of the endocrine system, are located on the superior border of the kidneys, one on each kidney. Each gland is comprised of two distinct parts, the medulla and the cortex, combined in a common capsule. The adrenal medulla is the core of the adrenal gland and is mainly composed of chromomaffin cells that convert the amino acid tyrosine into the catecholamines, epinephrine (adrenaline), norepinephrine (noradrenaline) and dopamine.

As part of the sympathetic nervous system, the adrenal medulla responds to stress in the body by secreting these catecholamines into the blood, producing the "fight or flight" response. The adrenal cortex is the outer layer and is responsible for converting cholesterol into glucocorticoids, mineralcorticoids and androgens. One of the major glucocorticoids produced by the cortex is cortisol, a hormone that is released in response to secretion of adrenocorticotropic hormone from the pituitary in response to stress.

Symptoms of adrenal exhaustion

  • Afternoon low between 3-4pm
  • Cognitive dysfunction
  • Craving sugar or salt
  • Decreased libido
  • Decreased tolerance
  • Difficulty concentrating
  • Insomnia
  • Anxiety
  • Confusion
  • Dark circles under eyes
  • Decreased memory recall
  • Depressed mood
  • Fatigue not relieved by rest
  • Lethargy

When the body comes under stress, its initial response, termed the alarm reaction, is to release catecholamines into the blood, stimulating the fight or flight response. The hypothalamic-pituitary-adrenal (HPA) axis, which is controlled through a negative feedback loop of cortisol to the hippocampal neurons, is also activated. Once the stress is removed, the body returns to normal, however if the stress is ongoing, the body enters the stage of resistance where its defences are elevated and levels of cortisol in the body remain high.

Finally, the body enters the stage of exhaustion where its defences are reduced, levels of adrenal hormones are depleted and progressive mental and physical exhaustion occur. Acute exposure to stress during this time may act to suppress the production of cortisol. Long-term activation of the HPA axis can lead to adrenal exhaustion as receptors in the hippocampus become desensitised and damaged due to prolonged or repeated alarm reactions, leading to the overproduction of cortisol. Depending on an individual's genetic makeup, in combination with their environment, any number of symptoms of adrenal fatigue can occur (see Table 1).

The most common symptoms of adrenal exhaustion are physical exhaustion, insomnia, irritability, and anxiety. These symptoms occur because both the body's blood sugar metabolism and its immune system are disrupted and cease to function normally. High levels of cortisol in the body can also result in increased fatty deposits, increased blood pressure, increased blood sugar levels and bone demineralisation.

In a healthy person, the body is well able to cope with stress. However under periods of prolonged and sustained stress, adrenal exhaustion can occur. Supporting the adrenal glands through changes via diet and lifestyle may prove beneficial.


Diet plays a key role in adrenal health. When the body is hypoglycaemic it releases cortisol, which stimulates gluconeogenesis and decreases insulin sensitivity. Snacking on simple carbohydrates and skipping meals will induce this response, as will repeated exposure to stressors. Consuming a well- balanced diet of complex carbohydrates, proteins, and fats will help to support adrenal health.

It is important to start the day with a good breakfast and then eat 5-6 smaller meals throughout the day to maintain normal blood sugar levels. Foods high in potassium such as bananas, figs and oranges should be avoided.

Chemical stressors, such as drugs and alcohol should also be avoided. Caffeine stimulates the central nervous system and exaggerates the stress response. It continues to amplify cortisol production hours after ingestion and actively contributes to adrenal depletion. Food and drinks containing caffeine, such as coffee and soft drinks should be avoided to help support adrenal function.


Most people live a fairly sedentary lifestyle, with high levels of psychological stress. This puts constant pressure on the adrenal glands, contributing to adrenal exhaustion. Regular exercise, 3-4 times per week, can work to help rebalance cortisol levels in a stressed body. Highly competitive exercise programmes may lead to added stress and should be avoided. Relaxing exercise such as yoga, walking and stretching can help to reduce stress, decreasing pressure on adrenal gland function. It is also important to work out the stressors in one's life and work to reduce these.

Regardless of the stressor, the body has just one response: activation of the HPA axis, which can lead to long-term health problems. Should you be suffering from physical exhaustion, insomnia, irritability and anxiety, there is a high chance your adrenal glands are overworked and you are experiencing adrenal depletion. It is these cases that direct treatment for adrenal fatigue may be required.

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Anderson, D. A. (2008). Assessment and Nutraceutical Management of Stress-Induced Adrenal Dysfunction. Integrative Medicine, 7, (5).

Alcamo, I. E. & Krumhardt, B. (2004). Barron's Anatomy and Physiology (2nd ed.). New York: Barron's Educational Series Inc.

Melmed, S. & Conn, P. M. (2005). Encocrinology (2nd ed.). New Jersey: Humana Press Inc.

Enotes: Encyclopaedia of Nursing and Allied Health (n.d.). Adrenal Glands. Downloaded from:

Holistic Online (2007). Our Body's Reaction to Stress. Downloaded from:

Integrative Psychiatry (n.d). Downloaded from:

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