Over the past four years, I have written a lot on the subject of mild hypo-cortisolism that is found in different conditions, that for lack of another well-established term, we call "adrenal fatigue" but it is often during the research I'm doing at any given time for articles etc..., that I find often, that many in the medical community, still do not recognize mild forms of adrenal insufficiency and they do not believe that adrenal fatigue syndromes exist.
I actually hope Doctors or knowledgeable people of any type, will make a suggestion for a name that doesn't come across as bogus and at the same time, if they don't believe sub-clinical forms of adrenal hypo-cortisolism exist, to also explain why all of the research articles that describe it, are somehow all collectively wrong on the subject (the later challenge will be much more difficult).
The majority of adrenal fatigue patients will at times have snap-shot readings that are normal, when blood tested for cortisol levels and they will also pass the ACTH Stimulation Test (confirms or rules out full blown adrenal insufficiency) and is why it is recommended to get multiple readings throughout the day, via saliva cortisol testing for milder forms of adrenal hypo-cortisolism.
When I had the ACTH Stimulation Test performed on me, my cortisol reading was about mid-range on the baseline reading however, I was anxious before and during the test and it's better to get cortisol rhythm of multi-readings during a normal activity day. Even though I had a normal baseline on that ACTH Stimulation Test, I also had a 24 hour urinary test through an Endocrinologist's Office and my cortisol averaged "10.7", with normal range at the lab being <119 for males ages 18 and above. To be in the middle of that one, I would have had to have a result of about a 50 or 60 and my Dr. admitted it was a very low reading for a 24 hour urine cortisol test. This confirmed I didn't have true, full-blown adrenal insufficiency but that I did have a serious case of adrenal fatigue.
In research articles, where patients with different diseases, are found to have low cortisol levels, the medical investigators are usually referring to "low cortisol" as being in the low-normal range, so is low compared to "controls" and low compared to normal subjects. They even give the number differences, calling them "significant" even when the difference is only 2 or 3 points lower than normal subjects have.
One statement the NIH makes in their Centers For Disease Control study of CFS, that has always stuck with me is this one; "Doctors have long known that even subtle deficiencies in cortisol is associated with lethargy and fatigue" (Oct, 1996).
I've lately come more to the conclusion that I've suspected from the beginning of researching on adrenal fatigue, that supplementing with DHEA, will help low DHEA levels but usually doesn't help with low cortisol. Maybe in some patients it does help to raise cortisol, once the circle of conversion goes completely around but there's conflicting info about DHEA out there. What will help the adrenals to produce more cortisol, are vitamins that support adrenal function, rest and adequate sleep and if needed, the safe and cautious use of licorice extract and adrenal glandular extracts. Some Doctors also sometimes prescribe; pregnenolone to adrenal fatigue patients or other combinations of hormones. A lot of medical resources say that the majority of women can safely take 25mg or less of DHEA and there is very low risk of it causing their androgen levels (male hormones) to go too high and men are supposed to be able to take up to 50mg safely. I don't feel DHEA would suppress cortisol to a significant degree at these doses but the point is that they also might not help raise cortisol, so that taking it alone, could cause more of a DHEA to cortisol ratio imbalance. This isn't true of people who have low DHEA but normal cortisol levels because DHEA is all they need in these cases. The Journal of Pharmacology has a research article that states that patients with Crohn's Disease and Lupus, are one example of low DHEA, that when supplemented, improves symptoms of these diseases but DHEA can become low for other reasons as well.
The "American Psychiatric Association", made a statement in the "American Journal of Phychiatry", in a research test that was conducted by 3 psychiatrists and 6 MDs. They stated that supplementing Post Traumatic Stress Disorder patients (PTSD) with low-dose cortisol, can help them because they found that the low cortisol found in this condition, is a major factor in symptoms. This study, which didn't go overboard with the dosing of cortisol, like others have, such as those experimenting with cortisol supplementing in CFS patients, had more favorable results.
There are now studies reported by the major medical research publishing groups that show that CFS patients did improve with lower-dose cortisol treatment. These studies are newer than the ones where they reported "adrenal suppression" and other adverse effects at higher dose treatment.
Cortisol replacement therapy is only available by prescription, by a licensed medical professional but hopefully as more research is done, they will find a safe dose that will help treat adrenal fatigue type syndromes.