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Adrenal Fatigue Article.

A hearty thank you to Holly Lucille, ND, RN, for a much needed expansion of our therapeutic considerations about the HPA axis. (Cover story, November, 2017)

What concerns me is that her article's catchy title and detailed text may mislead novice readers away from the very real possibility that many people DO have primary adrenal insufficiency.

For instance, consider the many millions with Hashimoto's thyroiditis and/or other autoimmune illness. Their often observed HPA axis dysfunction is likely due to some degree of concomitant autoimmune attack of the adrenal gland parenchyma. In these cases, the HPA axis issue might mainly be autoimmune adrenalitis. And, that condition is simply a mild version of what causes 70% of true Addison's disease.

Many of my patients with mild adrenalitis seem to need actual low-dose cortisol replacement, in addition to the many fine therapeutic suggestions outlined in the article.

Richard L. Shames, MD, author of Thyroid Power San Rafael, California

Dr. Lucille's Response

I agree one hundred percent with Dr. Shames's comments in regard to my article. My intent on the "catchy title" was to dissuade the use of the "catchy" and almost "slang" term "fatigue" when speaking about matters such as primary adrenal insufficiency and HPA axis dysregulation/dysfunction and as I mentioned, be more consistent with the literature.

Also, I am certainly in favor of low-dose cortisol therapy in clinical situations as Dr. Shames described. The conversation regarding autoimmunity is vast and needs to continue to be considered in so many of our patients presenting these days, so not only do we seek to treat the HPA or HPAT axis but also the autoimmune issue.

Holly Lucille, ND, RN

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Author:Shames, Richard L.; Lucille, Holly
Publication:Townsend Letter
Article Type:Letter to the editor
Date:Feb 1, 2018
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