Always Exhausted? Why Your Adrenal Gland May Be Failing — and What to Do Next

Feeling constantly drained — even after a full night's sleep — is not normal. If you're relying on caffeine to get through the day, crashing in the afternoon, or struggling with weakness, dizziness, or unexplained weight loss, your adrenal gland may not be working properly.

While many things can cause fatigue, one serious and often overlooked cause is adrenal insufficiency, a condition where the adrenal gland does not produce enough essential hormones. Left untreated, it can become life-threatening. The good news? It is diagnosable and treatable.

Let's break down what the adrenal gland does, how it can fail, and the medical steps you should take.

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What Does the Adrenal Gland Do?

You have two adrenal glands — small, triangular-shaped glands that sit on top of your kidneys. Despite their small size, they play a critical role in keeping you alive and functioning.

Your adrenal gland produces several vital hormones, including:

• Cortisol – Helps regulate metabolism, blood pressure, immune response, and your body's stress response
• Aldosterone – Controls sodium and potassium balance, which affects blood pressure
• Adrenaline (epinephrine) – Drives your fight-or-flight response

Cortisol is especially important. It helps your body:

• Maintain steady blood sugar
• Regulate inflammation
• Respond to physical stress (illness, injury, surgery)
• Maintain energy levels

If your adrenal gland cannot produce enough cortisol — and sometimes aldosterone — your body begins to struggle.

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What Is Adrenal Insufficiency?

Adrenal insufficiency happens when the adrenal gland does not make enough hormones, particularly cortisol.

There are three main types:

1. Primary adrenal insufficiency (Addison disease)

   • The adrenal gland itself is damaged
   • Often caused by autoimmune disease
   • Can also result from infections, bleeding, or cancer

2. Secondary adrenal insufficiency

   • The pituitary gland (in the brain) fails to signal the adrenal gland properly
   • Often caused by long-term steroid use

3. Tertiary adrenal insufficiency

   • Caused by suppression of the hypothalamus (often from chronic steroid therapy)

Addison disease is rare but serious. Secondary adrenal insufficiency is more common, particularly in people who have taken corticosteroids like prednisone for long periods.

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Signs Your Adrenal Gland May Be Failing

Symptoms often develop slowly and can be mistaken for stress, burnout, depression, or chronic fatigue. However, persistent symptoms deserve medical attention.

Common symptoms include:

• Constant fatigue that does not improve with rest
• Muscle weakness
• Dizziness or fainting when standing (low blood pressure)
• Unintentional weight loss
• Loss of appetite
• Nausea, vomiting, or abdominal pain
• Salt cravings
• Low blood sugar
• Mood changes (irritability, depression)
• Darkening of the skin (in primary adrenal insufficiency)

Symptoms often worsen during illness, injury, or major stress.

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What Is an Adrenal Crisis?

An untreated adrenal gland disorder can lead to adrenal crisis, a medical emergency.

Warning signs include:

• Severe weakness
• Confusion
• Severe abdominal pain
• Vomiting
• Very low blood pressure
• Loss of consciousness

Adrenal crisis requires immediate emergency care and intravenous steroids. Without treatment, it can be fatal.

If you or someone you know experiences these symptoms, seek emergency medical care immediately.

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"Adrenal Fatigue" vs. Medical Adrenal Insufficiency

You may have heard the term "adrenal fatigue." It is widely used online, but it is not a recognized medical diagnosis.

True adrenal insufficiency is a scientifically documented failure of the adrenal gland, confirmed with lab testing.

Chronic stress can affect energy levels and sleep, but it does not cause the adrenal gland to "wear out" in the way many websites suggest.

If you suspect a hormone problem, testing is essential. Self-diagnosing can delay real treatment.

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How Doctors Diagnose Adrenal Gland Problems

If your symptoms suggest adrenal insufficiency, your doctor may order:

• Morning cortisol blood test
• ACTH stimulation test (measures adrenal gland response)
• Blood tests for sodium, potassium, and glucose
• Imaging (CT scan) in certain cases

These tests are straightforward and can provide clear answers.

If you're experiencing several of the symptoms mentioned above and want to better understand whether they could be related to Adrenal Insufficiency (e.g. Addison Disease), a free AI-powered symptom checker can help you assess your risk and determine whether it's time to see a doctor.

This is not a replacement for medical care — but it can help guide your next step.

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Treatment: What Happens If Your Adrenal Gland Is Failing?

The good news: adrenal insufficiency is treatable.

Treatment typically includes:

Hormone Replacement Therapy

• Hydrocortisone, prednisone, or dexamethasone to replace cortisol
• Fludrocortisone (for primary adrenal insufficiency) to replace aldosterone

These medications are usually taken daily for life in primary adrenal insufficiency.

Stress Dosing

During illness, surgery, or injury, patients must temporarily increase steroid doses to mimic the body's normal stress response.

Emergency Injection Kit

People with adrenal insufficiency are often prescribed an emergency injectable steroid in case of adrenal crisis.

With proper treatment, most people live full, normal lives.

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Who Is at Risk?

You may be at higher risk for adrenal gland problems if you:

• Have an autoimmune disease (thyroid disease, type 1 diabetes)
• Have tuberculosis or certain infections
• Have a history of long-term steroid use
• Have had pituitary surgery or radiation
• Have unexplained low blood pressure

If this applies to you and you are experiencing ongoing fatigue, it is especially important to get evaluated.

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When Should You See a Doctor?

Speak to a doctor promptly if you have:

• Persistent, unexplained fatigue
• Unintentional weight loss
• Frequent dizziness or fainting
• Ongoing nausea or abdominal pain
• Skin darkening
• Symptoms that worsen during illness

Seek emergency care immediately if you experience:

• Severe weakness
• Confusion
• Severe vomiting
• Loss of consciousness
• Signs of very low blood pressure

Adrenal insufficiency is serious — but treatable. Early diagnosis makes a major difference.

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The Bottom Line

Your adrenal gland is small but essential. If it is not producing enough hormones, your entire body feels the impact.

Persistent exhaustion is not something to ignore. While many cases of fatigue are caused by stress, sleep problems, anemia, thyroid disorders, or lifestyle factors, adrenal insufficiency is a real and potentially dangerous medical condition that requires proper testing and treatment.

Do not self-diagnose. Do not rely on internet trends. Get evaluated.

If you're concerned and want to explore whether your symptoms align with Adrenal Insufficiency (e.g. Addison Disease), start by checking your symptoms with a free online tool, then speak to a doctor about appropriate testing.

If something feels seriously wrong — especially symptoms that could be life-threatening — seek medical care immediately.

Exhaustion may be common. But it is never something you should simply accept.