How To Diagnose Adrenal Fatigue - 3 Different Ways

Adrenal Fatigue is a phrase being thrown around a lot lately, especially in holistic circles. For a full list of Adrenal Fatigue symptoms and how to start healing it, read my post here

But first, how do you get a concrete diagnosis? I was diagnosed with severe Adrenal Fatigue in 2013, and have gone through several protocols to try to treat it but most importantly, trying to get to the bottom of why I have it in the first place.

It's extremely important to not only know IF you have it, but to understand HOW advanced it is. Adrenal fatigue affects immunity, disease, pregnancy, muscle strength, hormone production and about 100 different other body processes. You cannot let it go untreated.


Keep in mind, you can get a blood test that shows cortisol levels if your holistic doctor does a very extensive bloodwork. This is not an accurate reading because it only measures it at one time during the day and it also measures bound and unbound cortisol. The saliva test taken throughout the day, described at the bottom of this post, is the gold standard for diagnosis.

1. A comprehensive blood workup. If there is no cortisol measurement on your bloodwork, a trained holistic doctor can still tell if your adrenals are struggling by looking at your sodium and potassium ratios. This was the way I was first diagnosed.  I apologize for the crinkles - pretty sure I spilled something on it. It's like 2 years old okay. Here's what that looked like: 

2. Cortisol Stimulation Test. I went to Mayo a few months later for a bunch of issues. While I was there, I brought up the fact that my holistic Dr. had diagnosed me with Adrenal Fatigue. I knew they are very conventional so probably wouldn't respond well. They said, "Oh we don't really believe in that sort of thing here." Well, when they did my complete blood workup they tested my AM cortisol. And here was the result.

You can't read the reference range on this scan, but it's supposed to be 25. Well my AM cortisol was 5.2. So after seeing that, Mayo Dr. was like, "Well, we can do a cortisol stimulation test to see if they respond to stimulation." In other words, that is to see if they still work. Once you get to a certain point with adrenal fatigue there is no coming back. Then you get - Addison's Disease.

A stimulation test is basically a baseline measurement of your AM cortisol. Then they give you an IV of ACTH to stimulate them. They measure them at 30 mins and 60 mins afterward to see if there's a change. 

The good news is, my adrenals responded, which means they do work. In their words, my adrenals were "sleepy." I thought this was sort of hilarious. They couldn't just admit that I have adrenal fatigue. Anyway, the problem with conventional doctors is that they have no solution or help to give you unless you are to the point where you need drugs: Addison's Disease.

So, you have to find someone who can keep you from getting to that point.

3. 24 Hr. Cortisol Saliva Test. When I started working with Dr. Kalish in 2015, he suggested we do the 24 Saliva Test to see how my cortisol levels were throughout the entire day - not just in the AM. This is very important in determining your circadian rhythms and how you will treat your Adrenal Fatigue. You can't just take some generic “fix all” supplement for adrenals, or do what your friend is doing because we are all different. What if your cortisol is high in the morning, low in the afternoon, and then high at night? Or what if it’s a low all day long? Specific herbs and supplements are for calming and certain ones are for stimulating. 

Basically, you spit into a jar every four hours and they measure the hormones. Here is what the results look like:

I believe his words to me were, "Wow. You are really bad." He proceeded to tell me that I was probably in the bottom 10% of people he treated (sick wise). As you can see, my morning cortisol is not only way lower than the average person, but it is basically flatline all day. My overall sum cortisol for the day is 9.6 and should be from 23-42. Yup. In other words, I'M TIRED ALL THE TIME.

Wondering who's the mysterious wordy genius behind these posts? Follow this little rabbit trail to read more About Me! The use of the term genius is open to interpretation.