[quote]KSman wrote:
One can do a low dose HC trial and see if some symptoms are resolved. If so, you have individualized data and then you can disregard concerns about "Why assume that the cortisol levels should always be the same as “normal lab values”
And I guess another definition of adrenal fatigue is when “They rise in response to a stimulus. They fall when the stimulus is removed; that is how normal is defined.” does not happen. These stimulus/response does not get address with lab work. And when people feel run over after a major stress event, the following fall in levels with weak adrenal function may create levels that are really to low for normal function.[/quote]
Part of the problem with a fabricated “diagnosis,” like “adrenal fatigue,” which has no coherent definition, is that various phenomena are then offered as “proof.” You say it exists, mysteriously, and is something different than adrenal insufficiency.
Points:
–if someone’s cortisol level is high, how does giving them HC prove anything? (If you are talking about diagnostic testing for Cushing’s syndrome, the classic test is the dexamethasone suppression test. Oral hydrocortisone will be detected, if at all, along with native cortisone in a blood test; dexamethasone will not.)
–if someone’s cortisol level is normal, giving them HC may make them feel better, regardless of the adrenal state: a little more HC makes for an artificial sense of well being for all sorts of conditions in which the adrenals remain perfectly healthy.
–What I say regarding the normal physiologic response to physical stress is absolutely true, and to a degree, it is tautologic. A physical stressor is defined as one which raises the physiologic production of cortisol in normal subjects. A normal pitutitary-adrenal system returns to normal after the stress is removed.
Now, then, my friend KSman, let’s take an example from life. Suppose someone gets diverticulitis, and it perforates and causes peritonitis. Peritonitis is one of the worst acute inflammatory stressors; it can cause organ failure, coma, and–in people who are otherwise normal–ACTH and cortisol rise. And when it is resolved, cortisol homeostasis returns to normal. There is no “adrenal fatigue;” if there were such a thing, we would have to test every patient with pneumonia, infection, surgery, burns, etc., for…what? temporary insufficiency?
One might cavil that some patients become adrenal insufficient during such acute events, but that is not the “normal response.” Acute stress may reveal a (rare) underlying autoimmune hypoadrenalism, or hypopituitarism. (Proof: autopsy of patients with acute and chronic stress show adrenal hyperplasia, not involution.)
Last, human adrenal physiology has been under investigation for the better part of 60 years, and I cannot find a single peer-reviewed article or review in a literature search back to 1976 for anything called “adrenal fatigue.” Having said that, I create hundreds of patients each year who should have “adrenal fatigue” after medication or stress. And they do not have this entity–either they become Addisonian or they recover. If you want to prove the existence to me of this undefinable and insidious “disease” show me the article, the animal or human physiology, the biopsies of the adrenal glands.
Otherwise its handwaving, and “adrenal fatigue” is quackery to which its victims eagerly subscribe.