Adrenal Fatigue is by no means a modern discovery. Doctors in the eighteenth century were the first to recognize the signs of adrenal weakness, and it has been diagnosed with varying frequency ever since. On this page I will summarize how the understanding of Adrenal Fatigue developed in the early years, and how the perception of this condition has changed over time.
Addison’s disease and Adrenal Fatigue in the early years
The phrase Adrenal Fatigue wasn’t actually coined until 1998, when a chiropractor and naturopath named Dr. James Wilson began to recognize similar symptoms across a set of run-down, fatigued patients. Until that point it was known hypoadrenia, sub-clinical hypoadrenia, non-Addison’s hypoadrenia, adrenal neurasthenia, adrenal apathy and several other names.
The history of Adrenal Fatigue goes back to the 1800s, when doctors first began to understand the function of the adrenal glands and how they could affect energy levels, libido, immunity and more. Addison’s Disease (primary adrenal insufficiency) was initially recognized by Dr. Thomas Addison, who presented it to the South London Medical Society in 1849 as a “state of general anaemia incident to adult males”. Up until that point the utility of the adrenal glands had been a mystery to doctors, but the 70 years following Dr. Addison’s findings saw a wave of research into the adrenals and the new field of endocrinology.
In the late 19th century doctors began using porcine adrenal cells to treat cases of Addison’s disease and hypoadrenia. The first known use of this treatment was by a doctor named Sir William Osler in 1898, exactly 100 years before Dr. Wilson renamed subclinical hypoadrenia to Adrenal Fatigue. Although his first attempts were unsuccessful, adrenal extracts would later become a very popular treatment option, despite being eventually replaced by cheaper, synthetic compounds.
The early 20th century saw rapid development in the emerging field of endocrinology. Doctors began to understand the way that we produce and use hormones to control the various systems in our bodies. At this time there was the first split between those who acknowledged hypoadrenia (what we now call Adrenal Fatigue) and those who did not. Similarly to the situation we see today, proponents of the Adrenal Fatigue diagnosis argued that the black-and-white boundary between ‘healthy’ patients and Addison’s sufferers was over-simplistic, while the skeptics accused them of merely inventing a disease.
In 1919 an Italian Professor of Medicine, named Nicola Pende, conducted a review of the existing research into Adrenal Fatigue. He stated that “particularly important are those states of hormonic imbalance which are at the border line between health and disease, and which represent either latent or mild endocrinopathic conditions … It is already understood that for each of the best known endocrine glands, in addition to frank malfunctions there must be recognized minor degrees of perturbation.”
During the 1920s, 1930s and 1940s thousands of patients were diagnosed and treated for hypoadrenia. However this diagnosis of hypoadrenia gradually became less frequent. There was no test accurate enough to diagnose the milder form of adrenal dysfunction, and hypoadrenia did not get the recognition given to full Addison’s. Endocrinologists focused on conditions and diseases that were more readily diagnosed and treated. After that point, awareness fell until the late 1990s, when the work of Dr. Wilson, combined with more accurate saliva cortisol testing, once more enabled healthcare professionals to make a reliable diagnosis of Adrenal Fatigue.
The History of the Discovery of Addison’s Disease (The Royal Society of Medicine, 1950)
Hypoadrenia or “a bit of Addison’s disease” (RB Tattersall, 1999)
Modern medicine and Adrenal Fatigue
I have already touched on the controversy surrounding the modern diagnosis of Adrenal Fatigue. Despite recognizing other adrenal conditions like Addison’s disease and Cushing’s syndrome, mild adrenal insufficiency is not yet recognized as a problem by large parts of the medical community.
Thanks to the efforts of doctors and naturopaths like Dr. James Wilson, Dr. Michael Lam, Dr. Richard Shames, Dr. Christiane Northrup and many more, awareness is increasing among many MDs. In the area of functional medicine and naturopathy, Adrenal Fatigue is already a well-established condition that is regularly diagnosed and treated successfully.
The arguments for and against the existence of Adrenal Fatigue, or mild adrenal insufficiency, are more or less the same as they were 80 years ago. Proponents of the Adrenal Fatigue diagnosis maintain that to split the world into Addison’s sufferers and ‘healthy’ people, with nothing in between, is a gross simplification. They also state that modern lab tests use reference ranges that are too wide to pick up less serious forms of adrenal insufficiency like Adrenal Fatigue.
Opponents of the Adrenal Fatigue diagnosis argue that it is an invented condition, and that just because a severe illness (Addison’s) exists, does not mean that there necessarily has to be a milder form associated with it. Here I should note that this is exactly what used to be said about hypothyroidism, before mild hypothyroidism began to be widely recognized and treated by endocrinologists. Another argument put forward is that medical history is littered with so-called ‘fad’ diagnoses, and that Adrenal Fatigue is nothing but one of those. The counter argument to this, of course, is that medical textbooks are also full of diseases that were denied by the mainstream, before being established as genuine illnesses in need of diagnosis and treatment.
Fortunately, the tide seems to have turned. As functional medicine and naturopathy become more and more accepted (Canadian naturopaths can now give prescriptions, just like MDs), so Adrenal Fatigue is beginning to enter mainstream medical thought. This will take some time, but it now seems inevitable. In the meantime, your functional doctor or naturopath is perfectly equipped to give you a correct diagnosis of Adrenal Fatigue.
