Five Conditions That Mimic Adrenal Fatigue

Do you really have adrenal fatigue? Or is something else causing your fatigue?

The only way to determine this is to rule out all other conditions that can be mistaken for adrenal fatigue. There are five conditions whose symptoms can mimic adrenal fatigue. Before running a test for adrenal fatigue, I recommend you visit your family doctor to rule out the following five conditions:

1. Hypothyroidism (low thyroid hormone)
2. Anemia (low iron)
3. Depression
4. Chronic fatigue syndrome
5. Sleep disorders

1. Low thyroid (hypothyroid) and adrenal fatigue

In Canada, nearly 800,000 people have been diagnosed with hypothyroidism. As well, almost 10% of adults have low thyroid levels that still fall in a normal range. That means up to 3.7 million Canadians have low thyroid levels.(1)

Low thyroid levels often occur in a condition called Hashimoto’s thyroiditis. Hashimoto’s is the autoimmune form of low thyroid. Up to 80% of people who have low thyroid may actually be suffering from Hashimoto’s. (2)

Hypothyroidism is five to eight times more common in women than men and more common in women with small body size. (3)

The symptoms of hypothyroidism are very inconsistent. They depend on the patient’s age when hypothyroidism first started, how long it has lasted and how bad the hormone deficiency is. However, common symptoms of low thyroid include:

• Fatigue
• Cold intolerance
• Weight gain
• Constipation
• Dry skin
• Muscle pain
• Menstrual irregularities

Did you notice how so many of the low thyroid symptoms mirror the symptoms of adrenal fatigue?

There is an axis in your body that connects your brain to your adrenals glands, thyroid glands, and sex hormones. Therefore, if you have hypothyroidism, it’s common to also have adrenal fatigue. The same is true in reverse.

That’s why it is very importance to have your thyroid levels checked before starting an adrenal treatment protocol. You can perform a quick survey here to determine your risk of developing a thyroid-related illness.

2. Low iron (anemia) and adrenal fatigue

There are two different types of anemia. Most people are familiar with iron deficiency anemia. This anemia occurs when your body doesn’t have enough iron, so it is difficult to make red blood cells. Anemia of chronic disease (ACD) is the less common version. In ACD, anemia develops in response to a chronic illness. For example, up to 60% of patients with rheumatoid arthritis also have ACD. (4)

Classic iron deficiency anemia is more common than ACD. For this post, I’ll focus on anemia caused by iron deficiency.

Iron deficiency affects more than 12% of the world’s population, especially women of childbearing age, children, and individuals living in low- and middle-income countries. It’s the single most prevalent nutritional deficiency worldwide. (5)

The most obvious cause of iron deficiency is blood loss. This can come about through excessive blood donations, trauma, or heavy bleeding during the menstrual cycle. Other causes of iron deficiency include GI problems like infections and Celiac disease.

The common symptoms of iron deficiency include:

• Fatigue
• Weakness
• Headaches
• Irritability
• Exercise intolerance
• Shortness of breath (Exertional dyspnea )
• Vertigo
• Chest pain (Angina pectoris)

Again, the symptoms of iron deficiency look remarkably similar to that of adrenal fatigue. Since iron deficiency is so common, ensure the iron levels in your blood are checked regularly. Ruling in or out an iron deficiency should occur before treatment and diagnosis of adrenal fatigue.

3. Depression & adrenal fatigue

Depression and adrenal fatigue share many symptoms. So many in fact that it can be incredibly challenging to tell them apart. Unlike hypothyroidism or anemia, there is no laboratory test for depression.

So how can you tell the difference between adrenal fatigue and depression?

The Diagnostic and Statistical Manual of Mental Health Disorders is the guide most used by mental health professionals to diagnose clinical depression. It uses the following criteria:

1. Two to four of the following symptoms have been present during the same two-week period:
   • Depressed mood most of the day, nearly every day (dysphoria)
   • Markedly diminished interest or pleasure most of the day, nearly every day (anhedonia)
   • Significant appetite or weight change
   • Insomnia or hypersomnia nearly every day
   • Psychomotor agitation or retardation (observable by others)
   • Anergia – Fatigue nearly every day
   • Thoughts of worthlessness or inappropriate guilt nearly every day
   • Impaired concentration or memory nearly every day
   • Recurrent thoughts of death or suicide, or suicide attempt
2. At least one of the symptoms include a depressed mood (dysphoria) or diminished interest or pleasure (anhedonia).
3. The symptoms cause clinically significant distress of psychosocial impairment.
4. The symptoms are not due to a substance, medication, or general medical condition.
5. Persistent depressive disorder (dysthymia) and cyclothymic disorder are not present.
6. The mood disorder does not occur exclusively during a psychotic disorder.

Adrenal fatigue will often contribute to insomnia/hypersomnia, appetite changes, fatigue, and an impaired ability to concentrate. However, adrenal fatigue does not usually contribute to a marked decrease in pleasure throughout the day, suicidal thoughts, or a depressed mood. These alone can help tell the difference between the two conditions.

The role of adrenal fatigue

It is important to note that the connection between adrenal fatigue and depression is not a concrete boundary. I recommend thinking about the two as a spectrum. Adrenal fatigue can present as mild depression. If it remains untreated for a long period of time, this can result in clinical depression.

In fact, a 2016 article in the Journal of psychiatric research stated that adrenal fatigue plays a major role in major depressive disorders.(7)

In this particular study, it was found that those going through a major depressive disorder had low morning cortisol and low ACTH. These are two common findings in adrenal fatigue. (8) Even more important, the daughters of the women going through a major depressive disorder also had low cortisol levels. This means the daughters of the women studied also had adrenal fatigue. (9) The study concluded that this may be what predisposes depression among family members (especially through the maternal line).

Functional Medicine clinicians can run proper adrenal testing to determine whether your adrenal function is contributing to depression. I can’t recommend this step strongly enough.

4. Chronic fatigue syndrome and adrenal fatigue

There is no specific lab test used to diagnose Chronic Fatigue Syndrome (CFS). Therefore, getting a proper diagnosis can be incredibly challenging. In 2015, the Institute of Medicine revised the diagnostic criteria for CFS.

In order to be diagnosed with CFS, you must have the following three symptoms: (10)

1. Difficulty taking part in normal activities. Fatigue that started recently (is not a lifelong condition). This has lasted more than six months.
2. Fatigue after exertion (Post-exertional malaise)
3. Unrefreshing sleep that does not get rid of your fatigue

In addition to these symptoms, you must be suffering from at least one of the following two problems:

1. Cognitive impairment
2. Symptoms are worse while upright and improve when lying down (Orthostatic intolerance)

Because the way chronic fatigue is diagnosed is still being discussed, we currently don’t know how many people are suffering from it. Currently some estimates say between 1-2% of the population have chronic fatigue. (11)

There is no data showing that chronic fatigue syndrome and adrenal fatigue are connected. However, in my clinical experience, I often see adrenal fatigue as a contributing factor to chronic fatigue syndrome.

5. Insomnia and adrenal fatigue

Insomnia is a sleep disorder that affects your ability to either fall asleep, stay asleep, or sleep in. In order to be diagnosed with insomnia, these sleep problems have to exist even if you’ve giving yourself enough time to sleep each night. As well, the lack of sleep must affect how you function during the day.

There are two different types of insomnia. Short-term insomnia is diagnosed when the sleep issues have been occurring for less than three months. This type of insomnia is often triggered by a stressful event. In this condition, sleep usually improves after the stress has decreased.

Chronic insomnia is the second type of insomnia. Chronic insomnia is diagnosed if the condition has been occurring at least three times per week for a minimum of three months. (12)

Chronic insomnia that causes daytime fatigue may affect more than 10% of the population. (13) Those with a family history of insomnia are at greater risk. Common symptoms of insomnia include increased fatigue, sleepiness, confusion, tension, anxiety, and depression. (14)

I’ve previously explained the effect sleep (or lack of it) can have on adrenal fatigue. It is more likely that insomnia is a cause of adrenal fatigue than a misdiagnosis. Nevertheless, since sleep disorders can cause adrenal fatigue, they need to be ruled in/out.

There are other sleep disorders such as restless leg syndrome, circadian rhythm abnormalities (shift work), sleep apnea, and narcolepsy. The main symptom of each is daytime fatigue. In general, sleep disorders tend to be a cause of adrenal fatigue. Therefore, proper treatment of your sleep is essential.

Ok, now you know the most common conditions that mimic adrenal fatigue! Click here for even more information.