I prescribe a dose of Cortef/cortisol.
Adrenal fatigue is not a real diagnosis according to the Mayo Clinic. Look for real diagnoses like fibromyalgia or depression the web page suggests. No science.
There are decades of published, peer-reviewed research showing alterations in adrenal function in depression, chronic fatigue syndrome, fibromyalgia and other related conditions. The results are abnormal, but confusing and difficult to make sense of.
Adrenal function is regulated by a system of feedback loops. One structure in the brain, the hypothalmus, sends a message to another part of the brain, the pituitary, which in turn sends a message to the adrenal glands. The system is called the Hypothalmic-Pituitary-Adrenal axis. Abbreviated HPA axis. The brain is able to sense whether enough adrenal hormones are made and take corrective actions.
The same system works for thyroid and reproductive hormones.
Over-worked adrenals, secreting "stress" hormones such as cortisol and adrenaline, are unable to keep up with the demands placed on them. The whole HPA system becomes sick in variable ways.
Adrenal fatigue is associated with chronic debilitating illness like chronic Lyme disease.
The adrenal gland is complex in anatomy and function, releasing a wide array of hormones which I will not address here.
Organized medicine likes blacks and whites. There is no gluten sensitivity, only Celiac disease or not. Likewise, only extreme adrenal disorders, Cushings and Addison's disease are accepted. Black and white. No shades of gray.
The adrenal fatigue syndrome is associated with a plethora of symptoms : Total exhaustion. Lack of endurance. Anxiety, panic attacks and depression. Dizziness. Dizziness with standing. Aches and pains. Brain fog. Inability to cope with trivial stress. Fatigue more prominent in morning - or -evening. Second wind at night. Insomnia. Salt and/or sugar cravings. Weight gain. And numerous others.
Testing of saliva, urine and blood may give confusing results.
Cortisol levels peak level at around 8 am. There is a slight spike at 4 am. Otherwise, levels decline and stay low throughout the day and into the night.
For this reason cortisol should usually be given in the morning.
I have found measuring DHEA, another adrenal hormone, which can be supplemented, to be helpful.
For the most part, the diagnosis is clinical.
The immune system works better with small doses of cortisol called "physiologic", even though it is a "steroid." High doses of steroids suppress the immune system and must be avoided.
A little cortisol hopefully takes pressure off the overworked, dysfunctional, HPA, system. Hopefully the hormone can be gradually withdrawn as the disease abates. Tapering must be done slowly as the sleepy adrenals wake up.
The above patient needs to reduce stress, get more rest and eat a nutritious diet. She is a tough case.