These Tests Can Help Diagnose Adrenal Fatigue

Scott: You mentioned testing earlier. Is there a conclusive way we can tell that yes, this is the problem that I have. I do have adrenal fatigue?

James L. Wilson DC, ND, PhD: Well, there are certainly better ways. The unfortunate thing is the usual test that people do for the adrenals that medical doctors would do for the adrenals is called an ACTH challenge test. They give a synthetic ACTH, which is a hormone secreted by the pituitary gland and they see what happens to the adrenal glands.

That test was really designed to test for Addison's disease, the disease that destroys the adrenal gland. So, in a test of that kind, we wouldn't see a rise of the cortisol, but people with adrenal fatigue don't have an eaten away adrenal gland. They can still function. So, when they give them that ACTH test, they still pass it, but that doesn't mean they don't have some sort of adrenal dysfunction. It means it's not a structural, non-reactive function.

The best test is the test of salivary hormones. That's a very interesting, it's well established, over 3000 articles about how to do salivary hormone testing, and the scientific validity of it. They simply take a saliva sample, and that tests the pre-cortisol and DHEAS, another hormone secreted by the adrenal glands. And you can also test the other steroid hormones too, testosterone and estrogen, at the same time you're doing that. 

You can take a simple saliva test, and my suggestion is they take it during the day about four times: When they wake up, about 45 minutes after they wake up, about noon, about 4:00 in the afternoon, and then before they go to bed at night. There are about a dozen labs that do this in the United States. They can simply do this and find out if indeed their cortisol is having the typical fluctuations, because typically, cortisol is highest in the morning, about 45 minutes after you wake up. It goes through its low in the afternoon, comes back a little, and slow teeters down to being just a little bit above lowest when you go to bed at night. It stays pretty low until about 4:30 or 5:00 in the morning when it starts going up.

We see this diurnal pattern, we call it, and we know how to interpret this. Laboratories are used to interpreting tests, they do thousands of them. The laboratory that I'm most familiar with has done over a million of these tests. They know what's going on. 

Scott: Mm-hmm.

James L. Wilson DC, ND, PhD: So, in most cases, they'll be glad to talk this over with a person or with the doctor that orders the test, too. They cannot only have the test; they can have it interpreted, too. They can know whether or not it's a problem.

There's a questionnaire in the book that they can take, too. It's a questionnaire I used in my office for over 20 years. That will give them a really strong indication. That questionnaire usually corresponds with the levels of cortisol as they see it in a lab test, as well. 

You can also do a 24-hour urinary cortisol, and a catch urinary cortisol, but the most accurate one I've found, or the most helpful clinically, is the salivary hormone test.