Adrenal testing: should I be tested?

Adrenal insufficiency

Your adrenal glands make cortisol, a hormone you need every day. Adrenal insufficiency means they make too little. It is rare, but serious. Feeling tired on its own does not usually mean this. Some signs do raise concern: losing weight without trying, feeling dizzy or faint when you stand up, skin getting darker (especially in skin creases, gums or scars), and strong salt cravings. Taking steroid pills for a long time and then stopping is another reason to check. If any of these fit you, tell your doctor. A morning blood test for cortisol is the first step. If you feel very sick with vomiting, severe weakness or fainting, go to the ER. If you are worn out without these signs, look at sleep, mood and other common causes first.

Cushing's syndrome

Cushing's syndrome means your body has too much cortisol for a long time. It is rare. Extra weight, high blood pressure or tiredness alone do not usually mean you have it. Some signs make it worth checking: bruising easily, a round red face, weak thigh or shoulder muscles, wide purple stretch marks, or health problems unusual for your age, like thin bones in your 30s. If you have several of these, ask your doctor about testing. The tests are a bedtime saliva test, a 24-hour urine collection, or a pill-based test. A single blood cortisol level cannot prove or rule out Cushing's. Without these signs, Cushing's is unlikely to explain how you feel, even if a lab panel said your cortisol was off.

"Adrenal fatigue"

Not a recognized medical diagnosis — here’s what it usually means and what to ask about instead.

You may have heard of 'adrenal fatigue' as a reason for feeling exhausted, wired but tired, or unable to cope with stress. It is a popular idea, but it is not a recognized medical diagnosis, and no test can confirm it. Your tiredness is still real. The adrenal glands cause illness in two known ways: making too little cortisol or too much. Both have clear signs, like weight loss, dizziness when standing, darker skin, easy bruising or muscle weakness. Without those signs, feeling drained usually has another cause. Common ones are poor sleep, low mood, low iron, an underactive thyroid or burnout. These can be checked and treated.