significantly diminished in response to chronic stress. Although review of the medical literature confirms the pres- ence of primary adrenal gland dysfunction in patients with chronic fatigue syndrome and critical illness, a direct cause- and-effect relationship between chronic stress and adrenaUy mediated hypocortisolism remains unproven.
As such, a more physiological and clinically integrative approach is necessary to identify hypocortisolism as the pri- mary clinical aberration rather than to promote "adrenal fatigue" as the all-encompassing mold into which all forms of low-cortisol states must fit. This review discusses the numer- ous complex factors contributing to the evolution of hypocor- tisolism, as well as the metabolic and clinical consequences of this physiologic state.
Key Words: adrenal fatigue, adrenal gland dysfunction, hypocortisolism, hypothalamic-pituitary-adrenal (HPA) axis dysfunction, chronic fatigue syndrome, .salivary cortisol, sub- clinical Addison's disease, stress