Adrenal Insufficiency

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One of the most important factors in the GAS was found to be a previously
often neglected gland, the adrenal. This small gland, which weighs about as
much as a nickel and sits like a Bishop's cap on top of each kidney, is now
recognized as one of our most important endocrine glands (glands that
produce hormone-like substances discharged directly into the bloodstream).

The adrenal glands are composed of two parts--the medulla (inner portion)
and the cortex (outer surrounding portion). The adrenal glands produce many
substances, the most noteworthy of which are epinephrine, (previously known
as adrenalin), which is produced by the medulla; and the various sterols such
as cortisone and aldosterone, produced by the cortex.

Many observers believe that in hormonal responses to stress the adrenal
medulla is the primary agent. According to this view, stress on the body
stimulates (probably by way of the sympathetic nervous system) the adrenal
medulla to increased epinephrine production. This hormone increases the
secretion of adrenocorticotrophin (ACTH) by the pituitary, which in turn
activates the adrenal cortex to a greater production of corticoids such as
cortisone.

Cortisone and its related sterols have been used for years in treating all
forms of inflammatory reactions, from extremely severe diseases to mild skin
conditions. Inflammatory conditions usually respond quite rapidly to
cortisone therapy. Unfortunately, in chronic disorders cortisone usually doesn't bring
about a cure but only temporary relief. The reason for this is simple. The
production of cortisone and allied sterols represents only one step in the
general adaptation syndrome (GAS). These sterols rid the condition of
inflammation but they don't resolve other problematic aspects of the
condition. This must be done by other agents of the GAS activity. If the
endocrine gland system is weak and not able to carry on these activities,
the condition will revert to its inflammatory stage as soon as cortisone is
withdrawn. Because cortisone is notorious for its side effects when given
for any length of time, every physician tries to withdraw it as soon as
possible, if at all feasible. Although sterols are useful in serious cases and
undoubtedly have relieved much suffering, they are definitely not the answer
to a balanced glandular system. It is in the search for this balance that
this chapter is devoted.

So What Does This Mean to Me?

About this time, you may be asking yourself, "Very interesting, but what
does all this have to do with me?" It concerns you in this way. The General
Adaptation Syndrome is reacting in your body every moment of the day. As
long as it functions well, you should be healthy and contented. If it functions
poorly, you undoubtedly will be vexed with problems that often tend to cause
consternation among orthodox physicians. In fact, at the Beverly Hall
Corporation Healing Research Center our experience shows that most of the
misdiagnosed, neglected, and rejected patients who come to our doors are
victims of a malfunctioning General Adaptation Syndrome. Most of these
exhibit hypoadrenalism (also called hypoadrenia)--functional (non-disease-caused)
adrenal insufficiency. The adrenal glands of these patients, through
exhaustion, have ceased to function as well as they should, and they aren't
capable of putting out the normal complement of the substances required for
proper body function. Interesting in many of these patients they are
overexcited when they should rest and sleep and tired and weak when they
need to function. This seeming paradox is the "signature" of this condition.

There has been much research, particularly by Dr. John W. Tintera, relating
this condition to another common metabolic defect--hyperinsulinism (low
blood sugar). A great deal has been written in recent years about this connection.
The nutritionalist authors--Carlton Fredericks, E. M. Abrahamson, and Allan
Nittler--have all presented in great detail the symptoms, the methodology,
and the basic nutritional and supplemental care for these patients. Although I
agree with Tintera and others that many cases of hypoglycemia are caused by
malfunctioning adrenal glands, it's been my experience that patients can
have functional hypoadrenalism and all its symptoms without necessarily having
the hyperinsulinism of the low blood sugar syndrome. And hypoglycemic patients
do not always have lowered adrenal functioning, but many do.

Many patients come to our Center with typical symptoms of low blood sugar
who have had one, two, or even more normal glucose tolerance tests. Often, as an
empirical treatment, these patients had been placed on the low-blood-sugar
diet by their previous physician, but to little avail. Upon examination, we
usually find these patients suffering from adrenal exhaustion, which has not
yet manifested as hypoglycemia. Under treatment, these patients usually
respond well; almost without exception, they have been able to return to a
normal, productive life.

Functional adrenal exhaustion is poorly understood by most physicians, and
very little has been written for the general public on this condition.
Surprisingly, the earlier investigators in hormones and hormone therapy knew
it well. The reason it has been so ignored is difficult to explain. I
personally think this apathy has been produced by the general vagueness of
its character, the seeming neurotic symptoms of its victims, and the slowness of
its correction, even with the most advanced therapy. In our Center, I always
meet the newly diagnosed hypoadrenal patient with mixed feelings. I am, on
the one hand, very pleased to know that we have a patient who will once again
become useful and productive instead of being only half-functioning. On the
other hand, I always groan a little bit inside when I think of all the care,
time, and constant loving support necessary to carry this patient through
the seemingly nonproductive early stages of treatment. With perseverance,
however, they all respond. In the end, they prove to be among our most appreciative
patients, which gives the physician a great sense of accomplishment. (While
this paragraph was written over twenty years ago it is still as true today
as it was then.)

I mentioned earlier that the hypoadrenal syndrome has been known for some
time. To verify this statement I want to quote from one of the great early
investigators in glandular therapy, Dr. Henry R. Harrower, M.D., F.R.S.M.
(London). In his book Practical Organic Therapy, the Internal Secretions in
General Practice, Harrower had this to say:

"Since the adrenals are so extremely susceptible to so many outside
influences, it is likely that they would be easily worn out, and as a matter
of fact, functional hypoadrenia is as common a condition as any endocrine
manifestation. From a practical standpoint, this is an extremely important
symptom complex." Remember this was written just a short time after World
War I. Harrower goes on: "It is quite some years since Sajous began to emphasize
the importance of this condition, and while his opinions were scouted, and
some of his ideas declared visionary, it must be admitted that our present
knowledge of this subject is very much in harmony with the following
quotation from Sajous' monumental work: 'Functional hypoadrenia is the symptom complex
of deficient activity of the adrenals due to inadequate development,
exhaustion by fatigue, senile degeneration, or any other factor which
without provoking of organic lesions in the organs of their nerve paths, is capable
of reducing their secretory activity. Asthenia, sensitiveness to cold and cold
extremities, hypotension, weak cardiac action and pulse and anorexia,
anemia, slow metabolism, constipation, psychoasthenia are the main symptoms of this
condition.' "

Therefore we see that this condition was not only known in the early 1920s,
when Harrower wrote, but Harrower himself quotes Dr. Charles Sajous an even
more famous endocrinologist, who discussed it at a still earlier time.

Harrower goes on to say that "Hypoadrenia is a complication of all the
serious acute infectious fevers, since the adrenals are so intimately connected with
the driving of the body and are so susceptible to toxemia, that the ultimate
reduction of the accustomed adrenal stimuli is responsible for a slowing
down of many of the sympathetic controlled functions of the organism. Too often
this sympathetic asthenia is the actual cause of death from disease of this
character."

In such cases Harrower stated that, "Asthenia is the rule and muscular tone
(both striped and unstriped muscle) is poor. Exertion is difficult, if not
impossible, and the fatigue syndrome is prominent. The intestinal
musculature is inactive. Stasis, a common cause of hypoadrenalism, is also a usual
result of it. Mental exertion, even the simplest exertion, often causes so much
weariness and exhaustion as to be prohibitive. Mental elasticity is lost,
and there is both mental and physical depression with the fear that the
individual now can not accomplish his accustomed good mental work; and the story that
he 'has lost his nerve.' With this, one frequently notes a fearfulness of
making wrong decisions and vacillating and indecisive frame of mind. This is the
most usual form of adrenal insufficiency. It is chronic both in origin and in its
course."

Another section in Harrower's book is entitled "Neurasthenia as an adrenal
syndrome." The word neurasthenia isn't used as much as it once was, nor is
it well-understood by the general public as it was at one time. Neurasthenia
means weak nerves. Although they may not have heard of neurasthenia, we
frequently hear people speak of their weak or sensitive nerves and upset
nervous system. I personally still find neurasthenia an acceptable term and
an exact description of many patients we see daily.

Again, Harrower's report is so lucid that I am presenting the entire section
on neurasthenia:

Neurasthenia as an Adrenal Syndrome

"The minor form of functional hypoadrenia is more common than some have
appreciated, and the fact that there is a psychic origin as well as the
other physiologic causes already considered, allies it to the fashionable
neurasthenia of today. In fact, some have stated that what is improperly
called 'neurasthenia' is not a disease per se, but really a symptom complex
of ductless glandular origin and that the adrenals are probably the most
important factors in its causation. Campbell Smith, Osborne, Williams and
others, including the writer, have directed attention to the importance of
the adrenal origin of neurasthenia (though a pluralglandular dyscrasia is
practically always discoverable), but so far this is not understood as well
as its frequency and importance warrant.

"A few quotations from the literature will firmly establish the importance
of this angle from which to study this common and annoying symptom complex.
Quoting from the Journal A.M.A. (Dec. 18, 1915): 'The typical neurotic
generally has, if not always, disturbance of the thyroid gland. The typical
neurasthenic probably generally has disturbance of the suprarenal glands on
the side of insufficiency. The blood pressure in these neurasthenic patients
is almost always low for the individuals and their circulation is poor. A
vasomotor paralysis, often present, allows chilling, flushing, cold or
burning hands and feet, drowsiness when the patient is up, wakefulness on lying down
and hence insomnia. There may be more or less tingling or numbness of the
extremities.'

"Again, Kinnier Wilson in his monographs on The Central Importance of the
Sympathetic Nervous System, makes the following pertinent remarks: 'Many of
the common symptoms of neurasthenia and hysteria are patently of sympathetic
origin. Who of us has not seen the typical irregular blotches appear on the
skin of the neck and face as the neurasthenic patient 'works himself up into
a state'? The clammy hand, flushed or pallid features, dilated pupils, the
innumerable paresthesias (tinglings), the unwanted sensations in head or
body, are surely of sympathetic parentage. In not a few cases of neurasthenia,
symptoms of this class are the chief or only manifestations of the disease.
Here then, is a condition of defective sympatheticotonus; may it not have
been caused by impairment of function of the chromophil system? [Adrenal System]
..... There does not appear to me any tenable distinction between the
asthenia of Addison's Disease and the asthenia of neurasthenia. Cases of the former
are not infrequently diagnosed as ordinary neurasthenia at first. It is
difficult to avoid the conclusion that defect of glandular function is responsible for
much of the Central picture of neurasthenia.'

"Later this same author makes the following apothegm: 'Sympathetic tone is
dependent on adrenal support, and until the glandular equilibrium is once
more attained, sympathetic symptoms are likely to occur.' "

Interestingly, this quotation from the Journal of the American Medical
Association of 1915 postulates a relationship between neurasthenia and low
adrenal function. Yet to this day, such a relationship is rarely considered
in medical treatment. At the Beverly Hall Corporation Healing Research Center,
we consider such a cause and effect very common, and we treat accordingly. We
have become internationally known for our treatment of the weakened nervous
system.

Our treatment methods aren't so original or revolutionary; it's just that we
are willing to get down to causes and accept as facts the postulates of
Harrower, Sajous, and the many other brilliant investigators of those
earlier days. Their work showed that many emotional states have glandular causes. We
believe our duty as physicians is to find these causes and correct them
whenever possible. The path to follow has been shown. Harrower established
the basic treatment more than fifty years ago; yet today, not one physician in a
thousand is familiar with this malady even though his office may be jammed
with patients suffering from it. (This was true twenty years ago but not
now. These patients are now beginning to be recognized. The only problem is that
most physicians still have no idea of how to treat them or of the underlying
glandular weaknesses. Maybe in another twenty years?)

How Can One Tell if He Has Adrenal Insufficiency (Hypoadrenalism--Chronic
Fatigue Syndrome-Environmental Disease)?

Usually the first and most obvious symptom is tiredness, apparent laziness,
or lack of ambition. A young person often feels as if he has some serious
wasting disease. The young hypoadrenal patient usually is by nature a go-getter,
smart in school, and extremely conscientious. With hypoadrenalism, he finds it
more and more difficult to concentrate. The harder he tries to work, the more
tired he becomes. Parents and friends become alarmed, and the patient is usually
taken to a variety of physicians to correct the enigmatic condition.

In middle age, the hypoadrenal person usually feels he is just slowing down,
or that he is beginning to grow old prematurely. Again, he tends to push
himself to added effort. Sometimes he takes special exercises or courses to
stimulate mental activity. As in the younger person, the harder he tries,
the less he is able to accomplish. The situation can become so bad that the
hypoadrenal person may even become dizzy or have fainting spells, which
usually brings him to a physician.

In the elderly, this condition is blamed on old age. It is believed that Mom
or Dad is finally wearing out. But the symptoms of senility and of
hypoadrenalism are not the same; usually the difference can be discovered by
a physician reasonably versed in the latter disorder.

If hypoadrenalism is not diagnosed and treated in the early stages, the
patient will start to manifest symptoms that he takes as signs of mental
deterioration. He becomes more and more forgetful; he begins to have small
blacking-out incidents, and dizziness is particularly prevalent, especially
that which occurs on arising from a seated or reclining position. He begins
to fear that he has a brain tumor or perhaps cancer of some vital organ. The
most common fear however is fear of a mental disorder. This is the point at which
he is driven to seek medical attention.

Let's take a look at this picture. We have a person who is tired, much more
than he should be, has occasional dizzy spells, and has disturbing mental
aberrations--all contrary to his usual physical and emotional status. This
person had always been bright, overconscientious, a perfectionist by nature,
had an overabundance of energy, and had been able to drive himself
constantly to accomplish what he would with his life. Now this whole pattern is
reversed--not that his desires are gone, but the physical and mental
entities are no longer able to carry out the dictates of his will. This is most
frightening to any intelligent person, and is the sad story he pours out to
his physician.

Now let's put ourselves in the position of his physician and listen to his
story. You find before you a patient who is obviously intelligent, able to
present his symptoms with great lucidity, and yet whose symptoms don't seem
to fit any disease that you're familiar with. You find the patient excitable,
agitated, and apparently overly concerned. Although you aren't one to pass
snap judgments, your first thought is that he is becoming neurotic because
of the pressures in his life. You are, however, very thorough so you give him a
complete physical examination, a reasonably complete blood chemistry
examination, a urinalysis, and all the other things any physician should do
to discover a known pathologic condition that may cause such symptoms.

The tests all are within the normal range. The physical examination is
unremarkable. The patient's blood pressure might be slightly lower than
normal, but not seriously so, and of course it's only high blood pressure to
be worried about anyway. Slightly lower pressure just means that the man
will live longer.

Your examination confirms that you have before you a strong, healthy person
with symptoms that obviously are of a neurotic nature. He is probably just
overworked. So you talk to him. You recommend that he slow down, that he
find himself a hobby, or that he take a vacation.

You give him a mild tranquilizer, and if he feels depressed, you give him a
gentle antidepressant (Today Prozac is the fashion). Because he doesn't
sleep too well at night (insomnia being one of the symptoms of the second stage of
hypoadrenalism), you give him a mild sedative. You send him home with a
comforting pat on the back, reassuring him that there's nothing really wrong
with him, he's just been working too hard, and he's to settle down a bit,
keep on his medication, and try to get some enjoyment out of life.

This, in a nutshell, is the therapy most patients with hypoadrenalism
received twenty years ago. It was very professional and was usually given with the
best of intentions. Unfortunately, not only was it insufficient, but it also was
usually detrimental, because the various drugs put a greater strain on an
already overloaded glandular system. And so more problems are heaped on
those that already exist.

Today a few knowledgeable physicians will prescribe a more rational
treatment program, but even today, if our patients are any indication, the majority of
physicians are still treating this condition as they did in 1975.

Many patients, not realizing they have organic problems, continue with this
archaic treatment. Unless certain changes occur in their life that remove
much of the stress originally causing the condition, they will continue to go
downhill as they become more and more dependent on their drug therapy. The
drugs don't help the basic condition at all; the imbalances are all still
there. The drugs simply mask the patient's ability to be affected by the
symptoms.

If this condition goes unabated in some persons, it can in time lead to
mental institutionalization. Knowledgeable investigators frequently have found both
hypoadrenal patients and hypoglycemic patients in mental institutions. Many
of these patients are willing to admit themselves to mental institutions
because they have been told very clearly that they have no physical condition that
could cause their symptoms; yet these symptoms are so severe the patient no
longer feels capable of coping with society. This is a sad commentary on a
condition whose cause and treatment have been known for more than
seventy-five years.

When we first wrote about these patients we were seeing most of them in the
early stages of this condition. That is not true today. The majority of our
new adrenal patients today are in the second or third stage of the GAS as
outlined in the diagram of Dr. Selye. Rather than exhaustion being their
major complaint, nervousness, panic attacks and insomnia take first place with
fatigue being there but it is these other symptoms that bother them the
most.

II Corinthians 1: 4 - "[God] Who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble, by the comfort wherewith we ourselves are comforted of God." Visit Dominie's FMS/CFIDS Homepage at www.fms-help.com for Fibromyalgia and Chronic Fatigue Syndrome sufferers and their families.