My goal is not to get into detailed information, as some other sites have done a very good job of that.
Gail's Tips on Adrenals
Also, the book "From Fatigued to Fantastic" by Teitelbaum is very helpful on this topic. And there is a site www.fatigue1.homestead.com that I feel has done a great job of drawing together a lot of the lose strings on the topic of adrenals. See there are so many variations possible that it is very difficult to sort things out. One person may have low cortisol and low DHEA levels and hypoglycemia. Another may have low cortisol, high DHEA, and diabetes. Go figure. And then there are varying diagnoses like PIH, PCOS, etc to sort through. All that is beyond my scope and knowledge, except to say that it exists and you can go to that link and figure things out for yourself!
Now the one thing I would like to speak of is plain old, boring, "low adrenals". It is very difficult to get a diagnosis of low adrenals, because doctors are usually only familiar with the extreme level which is Addison's disease, where they are basically non-functioning and the person would DIE without supplementation. Because we don't die, they don't recognize us and let us suffer. Because we are a milder version of Addison's, you may find it helpful to do research on that topic. Also, Mercola has lots of interesting articles on adrenals.
There are various methods of testing for low adrenals:
1) bloodwork-This is typically done by an endocrinologist. He can do an ACTH (cortrosyn) stim test with the baseline early in the morning (7:30-8 am). Teitelbaum gives numbers on how to interpret the results. With results indicating low adrenals, the endo could then write you a scrip for cortef (synthetic cortisone). Also, you may need florinef (synthetic aldosterone), DHEA, etc.
2) saliva-Gail describes this. This ASI saliva test is more common with holistic practitioners, so your doctor may not be familiar with it. Obviously you have to use that test that your doctor can use to help you. If you want cortef and your endo likes blood, then bloodwork it is. If you have a doc who will go with saliva, then so be it.
I actually feel that there are some inherent weaknesses in the ASI saliva test, because you are essentially taking random samplings, even though they are at scheduled times, and this does not show the momentary flux of hypoglycemia. See, when the sugar crashes in a person with hypoglycemia, the adrenals surge to bump it back up (think adrenaline rush), and it is this cortisol, etc. surge that causes many of the hypoglycemia symptoms. So, if you extrapolate with me, if you take a sample at 8 am, it may be that you ate breakfast 1 hour before and now your sugar is crashing. Hence your cortisol levels read high when 5 minutes earlier they were low. Although this seems far-fetched, it is actually a scenario I have encountered with people (whose cortisol levels came back looking "good" on the ASI even though they had hypoglycemia and probable low adrenals).
3) hair analysis-This is what my doctor uses. It comes back with a report of possible problems based on the ratios of minerals in your hair. It is well known that certain physical problems result in particular mineral imbalance patters (thyroid affects calcium, adrenals affect sodium, etc.), so it can be a valuable tool and gives you a lot of "bang for the buck". It also comes back with a list of recommended supplements. My doctor uses Analytical Research Labs in Arizona, one of two recommended by Mercola.
As for treatments, the options are cortef, glandulars, or herbs. Cortef works well and can be a good option for many people. (Some people do not feel comfortable with herbs, want something covered by their insurance, or can't find a practitioner to guide them with holistic stuff.) Glandulars have their own concerns (risk of mad cow, not potent enough, lack of guidance as to what to buy, etc.), so that I do not recommend them except under the guidance of a skillful practitioner. With herbs, I know some people are using a product with contains licorice, siberian ginseng, etc. Siberian Ginseng is known to have a slight testosterone effect which may not be desirable for women and is questionable when lactating. The amount of licorice needed for effectiveness is rather large, and I personally got no effect from it (perhaps I did not take enough). I now take macca under the guidance of my doctor and am very happy with what it does for me.