> I’m curious what sort of stresses are thought to cause adrenal issues. Can they be environmental/situational vs. chronic hereditary?

“Adrenal fatigue” is an alternative medicine diagnosis. It’s a seductively simple narrative for people seeking answers to unexplained medical issues, but the theory is very much pseudoscience instead of actual science.

The biggest red flag for the adrenal fatigue theory is the claim that current blood tests are not sensitive enough to detect it. This is a common trick used by alt-medicine practitioners to dodge contrary evidence. We have medical tests to diagnose genuine adrenal insufficiency (Addison’s disease), but it’s an extremely rare disorder. Statistically speaking, you almost certainly do not have adrenal insufficiency.

The truth is that your adrenal glands are part of a larger system of feedback loops in your body. The adrenal glands don’t operate independently as the adrenal fatigue theorists would suggest, but rather they work in concert with your brain’s hypothalamus and pituitary in a feedback loop known as the HPA axis. Wikipedia can shed more light on the details of HPA axis functionality, but the key point is that the adrenal glands depend on inputs from your brain. That brings me to my main point:

> When doctors and specialists can’t figure it out they send you to someone else or suggest psychiatric issues.

Psychiatric issues can and frequently do manifest primarily as physical symptoms: Lack of energy, low stress tolerance, digestive issues, oversleeping or insomnia. These are hallmark symptoms of depressive disorders.

The fact that your symptoms started around the time of high stress at work combined with frequent, intense exercise is probably not a coincidence. It’s extremely common for people to notice the physical symptoms first and assume that their problem must be located outside of the brain. Your resistance to any psychiatric diagnosis is an extremely common response. Frequently, patients are offended by any suggestion that the origin of their problems is “all in their head” because it feels like a dismissal of their genuine physical symptoms.

However, the key thing to remember is that your brain and your body are not separate systems. They’re one in the same. It took me a long time to realize that drawing a line between mind and body is an artificial boundary that isn’t a helpful distinction when your problems almost certainly overlap both systems.

I think “adrenal fatigue” has become a popular alternative medicine diagnosis precisely because the adrenal glands are located outside of the brain. As I mentioned above, the adrenal glands take inputs from core brain structures. Your adrenals will only produce what the brain tells them to produce. Yet, no one wants to admit that their brain is right place to solve these issues, so they over-focus on the one part of the system that lies outside of the brain. Psychiatry and modern medicine has understood for decades that HPA axis abnormalities are intimately linked to depressive disorders, and that successful depression treatment in any form (therapy, medication, combination) normalizes HPA axis function. At this point, the hardest part is convincing patients to accept psychiatric treatment and give it appropriate time to work.

I’m glad to hear you’re feeling better, but I would encourage you to give your doctors a chance when they suggest psychiatric issues. You’re basically a textbook case of stress-related depressive symptomology. Modern psychiatry may not be perfect, but it’s better than years of unaddressed fatigue and suffering.