Why is my daughter so tired all the time?

MY DAUGHTER believes she has adrenal fatigue. She has found a lot of information online and I am worried about the tablets she takes every day. She is 33, but looks like a skinny 13-year-old. Please could you explain what adrenal fatigue is, how to treat it and where to get help. She also has difficulty absorbing nutrients — is this linked? Her GP is a good man, but can’t help her.

Mrs V. Bryan, Nottingham.

THE term adrenal fatigue is used to describe some nonspecific symptoms that include fatigue, widespread aches, nervousness, abnormal digestive function and disturbed sleep. the theory is that the chronic stress of modern life causes the adrenal glands — two walnut-sized glands above the kidneys — to become over-worked, so they fail to produce enough cortisone and other hormones, though at a level not detectable by current tests.

there are a number of books about adrenal fatigue, but they belong very much to the world of alternative medicine. Adrenal f atigue i s not an accepted medical diagnosis.

there are many who firmly believe in the concept of adrenal fatigue, and I respect their view that this is a mild, but undetectable form of adrenal insufficiency, though I would not diagnose it.

there is, however, a form of adrenal insufficiency doctors do recognise, which is known as Addison’s disease. A rare condition, it is diagnosed after investigations, including blood tests, confirm low levels of cortisone and aldosterone.

these hormones are involved in many bodily processes, so a reduced level can result in symptoms, including fatigue, aches, weight loss, low blood pressure and darkening of the skin. tests can pin down the cause, such as an auto-immune disease or infection preventing the Your glands from functioning properly.

daughter has persisting symptoms that her GP could not readily explain, and this is frustrating. However, accepting the view from non-medical sources that it is adrenal fatigue may be unwise, even dangerous, because if she has a condition yet to be diagnosed, she may become more ill while taking an alternative treatment.

Your point about problems in absorbing nutrients only serves to underline my suspicion that there is a diagnosis yet to be made.

Fatigue is a common complaint affecting more than 5 per cent of people at any time. It must be distinguished from sleepiness, breathlessness and weakness; the terms lack of energy and loss of stamina are often used instead. It is a major symptom, one not to be ignored, and is associated with many conditions.

these include infections (from tB to viral infections to parasites), heart problems, hormonal disorders (such as diabetes, thyroid and adrenal disorder), metabolic disorders (liver or kidney disease) and psychological disorders (depression and disturbed sleep).

Your daughter should undergo re-evaluation with someone with an open mind for what the evidence shows: and this means the evidence of reliable diagnostic medicine.

If her GP can offer nothing further, the opinion of a consultant physician, an expert in general diagnostic medicine, should be sought (via referral from the GP) — if your daughter will accept this in the face of her firmly held self-diagnosis. MY WIFE has endured nearly seven months of hives, which she scratches until they bleed. Our local hospital’s skin specialist diagnosed urticaria. Months on, despite a variety of anti-histamines, the problem continues. It is tolerable to a degree in the daytime, but appalling at night. She’s had a biospy and a wide spectrum blood test — both were OK. Do you have any suggestions?

Jon Cole, Portsmouth. urtICArIA is named after the stinging nettle, urtica dioica, because it can look like a nasty nettle rash. Also often called hives, it appears as a raised rash on the skin, but unlike the painful nettle rash, it is intensely itchy.

It may affect up to 20 per cent of us at some stage.

When it clears completely in under six weeks, it is known as acute; when it continues for longer, as in your wife’s case, it is chronic. In acute urticaria, a trigger can often be identified, such as a medicine, But food, insect sting or infection.

once the urticaria is classed as chronic, it is unusual that we can pin down an allergic cause or other trigger. However, it can be associated with a number of autoimmune disorders including thyroid disease, coeliac disease, rheumatoid disease and type 1 diabetes.

this is why the detailed blood testing (wide spectrum blood test) that your wife had is so valuable.

A skin biopsy is not a routine test, but should be carried out if the individual weals persist longer than 24 hours (each usually comes and goes within minutes or hours).

the aim is to exclude urticarial vasculitis, where blood vessels in the skin become inflamed.

We do not understand the exact cause of chronic urticaria, though it’s likely to be an autoimmune problem, where the body attacks its own tissues.

the condition causes considerable distress, waxing and waning and often proving difficult to treat. However, ultimately it should get better on its own. Half of all patients recover within a year.

Most patients are treated with antihistamines initially, as the condition is often assumed to be the sign of an allergy. this may be supplemented by short courses of corticosteroids, such as prednisolone, which suppress the immune system and are anti-inflammatory.

the response to antihistamines is variable, and some patients may be taking up to four times the standard dose. the tablets, such as cetirizine, loratidine or fexofenadine, should be taken regularly.

If the symptoms are still poorly controlled, we may add the drugs cimetidine or ranitidine (usually prescribed for stomach ulcers) because these are known to dampen down the release of histamine.

A third step is to add montelukast, a drug that is thought to calm i nflammation. Many patients require several medications to control symptoms.

If these persist, the diagnosis becomes r efractory chronic urticaria. there are a number of therapies for this, particularly omalizumab, a monthly injection that may cost several thousand pounds a year. this highly specialised treatment must be conducted under the care of a consultant dermatologist in a specialised unit.