very good article of Dr. Bryan Walsh

Adrenal Fatigue: The Real Story
There’s a lot of crap out there. Foot baths, colon cleanses, ear candling, liver/gall bladder cleanses… it’s no wonder why people question alternative medicine. Well, here’s another one: adrenal fatigue.
To be honest, I feel sorry for the adrenal glands. They’re the ultimate scapegoat for alternative practitioners today. When in doubt, blame the adrenal glands! No other part of the body garners as much attention and blame as the adrenal glands when something is amiss in the body.
Can malfunctioning adrenal glands really cause issues?

It All Starts In The Brain (The Really Technical Stuff)
Adrenal gland function and release of cortisol is a coordination of three different structures in the brain:
1. Hippocampus — Inside the temporal lobe of your brain, the hippocampus regulates the circadian rhythm of the hypothalamus-pituitary-adrenal (HPA) axis.
2. Mesencephalic reticular formation (MRF) — Within the brain stem itself, the MRF is responsible for promoting a sympathetic response in the body. It does so via excitation of the intermediolateral cell column (IML) in the spinal cord, which stimulates the adrenal medulla to release epinephrine and norepinepherine.
3. Hypothalamus — There are a number of nuclei within the hypothalamus, one of which is called the paraventricular nucleus (PVN). The PVN of the hypothalamus receives a variety of inputs that ultimately results in secretion or suppression of cortisol by the adrenal glands.

The Stress Response, 2010
The PVN is considered to be the final common structure where numerous different inputs initiate a stress response. Cytokines from the immune system, neurotransmitters from the nervous system, input from the limbic system (emotions), and hormones from the endocrine system all converge to elicit a stress response from the HPA axis at the PVN.
There’s a concept in neurology called the central integrative state, which basically states that the net output of a neurological structure is a summation of the excitatory inputs versus the inhibitory inputs. In other words, if a combination of stimulus from neurotransmitters, hormones, and cytokines all result in an excitatory state, the result will be an elevation of cortisol.
On the other hand, if the combined total input is that of an inhibitory response, the results will be a low output of cortisol. This is how someone can go directly to the adrenal exhaustion phase: If the total summation of inputs is inhibitory to the PVN, there will be a diminished adrenal response and low cortisol.
Using this model, there’s no such thing as “adrenal fatigue.” Rather, it’s merely a lack of inputs that can generate an adequate adrenal response.
The following can excite the PVN and therefore contribute to high cortisol: insulin, acetylcholine, elevated epinephrine and norepinepherine, and Th2 cytokines (IL-4, IL-5 and IL-10).
The following can inhibit the PVN and therefore contribute to low cortisol: GABA, low epinephrine and norepinepherine, endothelial nitric oxide, interferon, tumor necrosis factor, and Th1 cytokines (IFG, IL-12, TNF).
So the next time someone tells you, “Dude, you wore your adrenals out!” You can respond, “No, I probably inhibited my paraventricular nucleus.”

Symptoms and What To Do
Symptoms can help point you in the right direction:*
Symptoms of hyperadrenal states include: difficulty falling asleep, allergies, excessive perspiration, and gastric ulcers.
Symptoms of low adrenal states include: difficulty staying asleep (waking up during the night), dizziness when standing quickly, blurred vision, shakiness or lightheadedness between meals, and relief of fatigue after eating.
Symptoms aside, laboratory testing is your best bet. The preferred method is salivary testing due to the ease of measuring circadian rhythm.
This type of testing utilizes four salivary samples throughout the day and averages out the total production of DHEA to help evaluate adrenal function. The adrenal salivary test not only allows you to evaluate adrenal function, but can also give implications into the function of degree of hippocampus destruction as well. It’s a great test.
While the details of interpreting this test are beyond the scope of this article, here are some generalities you can use:
1) Chronically elevated cortisol:
a. Phosphatidylserene — 2g a day in divided doses
b. Adaptogenic herbs — panax ginseng, rhodiola, ashwaganda, eleutherococcus
c. Cytokine support — resveratrol, pycnogenol, green tea extract, pine bark extract
d. Neurotransmitter GABA support — taurine, valerian root, passion flower, L-theanine
2) Chronically depressed cortisol:
a. Licorice root extract — Dosages depend on the type of licorice root extract used
b. Adaptogenic herbs — panax ginseng, rhodiola, ashwaganda, eleutherococcus
c. Cytokine support — Echinacea, astralagus, shiitake mushroom, beta-glucan, beta sitosterol
d. Excitatory neurotransmitter support — acetylcholine (Alpha-GPC, huperzine, galantamine), serotonin (5-HTP), tryptophan, St. John’s wort
3) Abnormal circadian rhythm:
a. Acetylcholine support — Alpha GPC, huperzine, galantamine
b. Phopshytidylseriene — 2g a day in divided doses for minimum of 6 months

Summary
Adrenal gland dysfunction is real. However, the way it’s explained and treated by many integrated practitioners today is an outdated and incomplete model.
With new research and a deeper understanding of how systems of the body work, our methods of treatment should evolve. Hopefully this article has lead to a greater degree of understanding of an otherwise misunderstood and overused concept!