Our current understanding of adrenal function is still at its infancy at best. It is therefore very difficult for any health professional to have a good grasp of the Adrenal Fatigue condition from a purely pathological and physiological perspective. The number of physicians with true expertise in advanced Adrenal Fatigue is very small. Those who are good in this gain their expertise not from textbooks, but from years of clinical experience. There is no short cut, because text-book cases are few and far between. Because the full recovery cycle can take years to complete in severe cases, practitioners with little experience will find it hard to handle cases other than the most mild and straight forward ones.
Variability in cortisol assays creates an additional problem with setting criteria for a normal response to ACTH that apply to all centers. Two studies comparing cortisol results obtained with different assays showed a positive bias of radioimmunoassays and immunofluorometric enzyme assays of 10 to 50 percent compared with a reference value obtained using isotope dilution gas chromatography-mass spectrometry. As a result, in one study, depending on the combination of assay and criterion used, between 0 and 100 percent of healthy volunteers would be considered to have a normal response to ACTH. This illustrates the difficulty of interpreting cortisol responses that are close to the cutoff point. (3)