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Dr. Wayne Evron Puts the Concept of Adrenal Fatigue to Bed
By Nancy Kennedy

Wayne A. Evron, MD, FAACE

"Adrenal fatigue" is a popular diagnosis within the alternative medicine industry. Practitioners, including some nutritionists, naturopaths and chiropractors, attribute it to the unrelenting stress of 21st century lifestyles. Symptoms of adrenal fatigue, they claim, include poor sleep, tiredness, weakness and food cravings, and treatment typically involves purchasing expensive over-the-counter nutritional supplements and following a special diet, to restore the depleted adrenals and raise levels of the hormone cortisol. Some even recommend steroids to their patients. But according to one of the Pittsburgh region's foremost experts in the medical specialty of endocrinology, adrenal fatigue simply does not exist.

"Adrenal fatigue is not a medical condition," says Wayne A. Evron, MD, FAACE, who is board certified in both internal medicine and endocrinology and recently joined the staff of St. Clair Hospital. "Adrenal fatigue originated in the alternative medicine field, where it is considered a chronic debilitating condition that has reached epidemic proportions, especially among women. However, the idea that stress depletes cortisol is not true; there's no scientific evidence to support the concept. The so-called symptoms of adrenal fatigue can be due to a number of factors, including depression, poor nutrition, sleep disorders, menopause – and stress. But we don't need to be taking steroids during times of stress. In the absence of true adrenal disease, which is rare, the adrenal glands do their job effectively and consistently. They don't get tired; they don't become depleted and they don't burn out."

The adrenal glands are two tiny but powerful endocrine glands that sit at the top of each kidney. These glands are an integral part of the body's fight-or-flight response that helps enable our survival. In times of physical and mental stress, they produce hormones in response to signals from the brain; these hormones give the body energy boosts when needed and are essential to life. Evron says that major surgery is an example of the type of physical stress that triggers the release of adrenal hormones.

The adrenals have two parts: the interior part, the medulla, secretes epinephrine and norepinephrine, which help regulate heart rate and blood pressure. The outer layer, the adrenal cortex, produces cortisol, a glucocorticoid hormone that controls glucose metabolism, and aldosterone, which helps regulate fluid and electrolyte balance. The cortex also secretes androgen.

Evron says that it is normal for cortisol levels to fluctuate. "There's a diurnal variation in levels of the adrenal hormones. Cortisol levels are highest in the morning and fall through the day. Overnight, the levels rise. People who have clinical depression lack this diurnal variation; their levels remain elevated and thus they cannot sleep well.

"Adrenal hormone levels normally drop as we age. Although these lower levels are sometimes referred to as adrenal fatigue, it's due to aging and not stress, and it isn't a disease. There's no need to treat it. Putting people on prednisone to treat 'adrenal fatigue' is dangerous. People seem to believe that steroids are a cure-all, but you can develop Cushing's Syndrome from steroid use, and risk developing osteoporosis, obesity and steroid psychosis."

Although true disorders of the adrenal glands are rare, Evron says that there are several serious conditions that occur when the adrenals over or under-produce hormones. Cushing's syndrome means that there is excessive cortisol in the blood, usually as a consequence of an adrenal or pituitary tumor. Cushing's Syndrome is rare and 70% of cases occur in women. Symptoms of Cushing's include the characteristic "moon-face" as well as hirsutism, fatigue, diabetes and depression. Cushing's Syndrome is treated by surgical removal of the tumor. Addison's Disease, or adrenal insufficiency, means that the adrenals are under- producing cortisol and aldosterone. "This is the condition that afflicted President Kennedy and is characterized by weight loss, nausea, fatigue, skin darkening and low blood pressure," explains Evron. "Addison's is usually due to destruction of the adrenal cortex in autoimmune disorders, but severe infections such as tuberculosis and HIV-related fungal infections can cause it. If a person on long term steroids such as prednisone stops taking it abruptly, a dangerous drop in cortisol may result. Treatment of Addison's consists of cortisol replacement with daily medication. When a person with adrenal insufficiency has surgery, they need to be monitored by an endocrinologist and given pre-op administration of hydrocortisone."

Evron says that cancer can afflict the adrenal glands. "Benign adrenal tumors are common; 10-20% of the population has them but without symptoms. Cancers in other parts of the body, such as breast cancer, can spread to the adrenals."

Evron, who resides in Mt. Lebanon, is a graduate of the University of Pennsylvania School of Medicine. He completed an internship in internal medicine at the University of Florida, and both his residency and fellowship in endocrinology at UPMC-Presbyterian Hospital. He previously served as the Director of the Joslin Diabetes Center at West Penn Hospital and as a Clinical Assistant Professor for the Temple University School of Medicine.

To have healthy adrenal glands, Evron recommends taking good care of your general health, especially getting restful sleep and learning to manage stress. "Stress can be harmful when it is severe and prolonged, but it can be reduced. Daily stress is a fact of life, but it does not exhaust the adrenals."

Dr. Evron can be reached at Evron Endocrinology Associates at (412) 942-7295.

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