A position statement by the American Association of Clinical Endocrinologists (AACE) published in Endocrine Practice is aimed at raising awareness in the medical community about the risks of off-label use and misuse of hormones and dietary supplements.1

In recent years, there has been an increasing trend worldwide in dietary supplement use. These products are usually advertised as safe despite limited or no data to support their efficacy or safety, and they are often taken without the supervision of a healthcare provider.1

Major concerns regarding the unsupervised use of dietary supplements result from the lack of rigorous assessment before distribution; as such, they may contain undeclared pharmaceuticals or unregulated hormones.1

Adrenal Fatigue: Origins and Evidence

In his 2001 book entitled Adrenal Fatigue: The 21st Century Stress Syndrome, James L. Wilson, DC, ND, PhD, a naturopath and chiropractor, coined the term “adrenal fatigue,” which is claimed to be the result of overuse of the adrenal glands.2,3 According to this theory, adrenal fatigue develops secondary to chronic or extreme stress and is characterized by a constellation of common nonspecific symptoms, including physical and mental complaints.2,3

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A 2016 systematic literature review of adrenal fatigue including data from 58 studies concluded that the studies were highly flawed, providing conflicting results and inappropriate conclusions. The review authors concluded that the current evidence does not support the existence of adrenal fatigue or the usefulness of adrenal supplements.3

Off-Label Use of Adrenal Supplements

Although the Endocrine Society and the Hormone Health Network do not recognize adrenal fatigue as a legitimate medical condition, there are many websites that provide information on this topic, along with unfounded recommendations for self-diagnosis and options to purchase adrenal supplements to treat this condition. The proponents of adrenal fatigue support the use of glucocorticoids as well as over-the-counter supplements.1

While glucocorticoids are indicated for several medical issues, including adrenal insufficiency and inflammatory diseases, their use for the controversial diagnosis of adrenal fatigue is off-label. Studies to assess the effectiveness of hydrocortisone and fludocoritsone for patients with chronic fatigue syndrome have reported conflicting results and a randomized placebo-controlled double-blind study showed no beneficial effect of a combination of low-dose hydrocortisone and fludocoritsone on chronic fatigue.1

This article originally appeared on Endocrinology Advisor