Adrenal fatigue does not exist. A systematic review of the medical literature
Data
2016-12-31
Autores
Cadegiani, Flavio Adsuara 
Orientadores
Kater, Claudio Elias
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Background: The term “adrenal fatigue” (“AF”) has been used by some
doctors, healthcare providers, and the general media to describe an alleged
condition caused by chronic exposure to stressful situations. Despite this, “AF”
has not been recognized by any Endocrinology society, who claim there is no
hard evidence for the existence. The aim of this systematic review is to verify
whether there is substantiation for “AF”. Methods: A systematic search was
performed at PUBMED, MEDLINE (Ebsco) and Cochrane databases, from the
beginning of the data until April 22nd, 2016. Searched key words were: “adrenal”
+ “fatigue”, “adrenal” + “burnout”, “adrenal” + “exhaustion”, “hypoadrenia”,
“burnout” + “cortisol”, “fatigue” + “cortisol”, “clinical” + “burnout”, “cortisol” +
“vitalility”, “adrenal” + “vitality”, and “cortisol” + “exhaustion”. Eligibility criteria
were: (1) articles written in English, (2) cortisol profile and fatigue or energy status
as the primary outcome, (3) performed tests for evaluating the adrenal axis, (4)
absence of influence of corticosteroid therapy, and (5) absence of confounding
diseases. Type of questionnaire to distinct fatigued subjects, population studied,
tests performed of selected studies were analyzed. Results: From 3,470 articles
found, 58 studies fulfilled the criteria: 33 were carried in healthy individuals, and
25 in symptomatic patients. The most assessed exams were “Direct Awakening
Cortisol” (n=29), “Cortisol Awakening Response” (n=27) and “Salivary Cortisol
Rhythm” (n=26). Discussion: We found an almost systematic finding of conflicting
results derived from most of the studies methods utilized, regardless of the
validation and the quality of performed tests. Some limitations of the review
include: (1) heterogeneity of the study design; (2) the descriptive nature of most
studies; (3) the poor quality assessment of fatigue; (4) the use of an
unsubstantiated methodology in terms of cortisol assessment (not endorsed by
endocrinologists); (5) false premises leading to an incorrect sequence of research
direction; and, (6) inappropriate/invalid conclusions regarding causality and
association between different information. Conclusion: This systematic review
proves that there is no substantiation that “adrenal fatigue” is an actual medical
condition. Therefore, adrenal fatigue is still a myth.
Descrição
Citação
CADEGIANI, Flavio Adsuara. Adrenal fatigue does not exist. A systematic review of the medical literature. 2016. 68 f. Dissertação (Mestrado em Medicina: Endocrinologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2016.