Are Your Adrenal Glands Fatigued?

When do you need adrenal support? You only need it whenadrenal hormone production is inadequate or at meaningful risk of becoming inadequate. In a person with normally functioning adrenal glands, there generally isn’t evidence that the adrenals need to be supported with supplements.

Sadly, though, so many of us are under constant stress, and that means the adrenal glands can become strained and overworked. The adrenal glands make cortisol, which is essential for maintaining blood pressure, blood glucose, metabolism, immune/inflammatory regulation, and the body’s response to physical stress. The glands also make aldosterone, which helps regulate sodium, potassium, fluid balance, and blood pressure.

Symptoms that can suggest adrenal insufficiency include persistent fatigue or weakness, low blood pressure or dizziness, nausea/vomiting, abdominal symptoms, loss of appetite or weight, low sodium, and sometimes low blood glucose. These symptoms are nonspecific, so diagnosis generally requires laboratory evaluation rather than symptoms alone.

The Adrenals and Cancer

Someone with cancer might need medical support for adrenal function, but cancer itself does not automatically mean the adrenal glands need support. The key issue is whether the cancer or its treatment has impaired the body’s ability to produce enough cortisol, an essential hormone for responding to physical stress.

In cancer care specifically, adrenal function may need attention when a patient has adrenal insufficiency, which can occur because of disease involving the adrenal or pituitary glands, certain cancer therapies, or prolonged corticosteroid treatment (such as prednisone or dexamethasone) followed by withdrawal. If steroids are reduced or stopped too quickly, the body may temporarily be unable to produce enough cortisol.  During serious illness, surgery, infection, or other major physiologic stress, someone with adrenal insufficiency may require additional prescribed glucocorticoids because the body cannot produce the normal cortisol surge.

This can happen for several reasons. Long-term corticosteroid treatment (such as prednisone or dexamethasone) can suppress the hypothalamic-pituitary-adrenal axis; Immune-checkpoint inhibitors can cause inflammation of the pituitary gland or, less commonly, the adrenal glands, resulting in adrenal insufficiency. Cancer involving both adrenal glands or the pituitary can also interfere with hormone production. Surgery or radiation involving these structures can occasionally have similar effects.

Cortisol becomes particularly important during cancer treatment because infection, surgery, chemotherapy complications, and other serious illnesses increase the body’s physiologic stress. A person with adrenal insufficiency may be unable to generate the normal increase in cortisol and can develop profound weakness, nausea or vomiting, low blood pressure, low sodium, low blood sugar, and potentially a life-threatening adrenal crisis.

When adrenal insufficiency is suspected, clinicians will usually order tests like morning cortisol and ACTH, and perhaps an ACTH (cosyntropin) stimulation test. Confirmed deficiency is generally treated with prescribed hormone replacement, such as hydrocortisone.