Re: Vitamin A = Lethargy, Joint Pain, and more...
can you give a few more specifics?
you said you have tried paleo, but have you tried any raw paleo. i wouldn't go into it hog wild, just try a few things to start off and see how it goes.
for example taurine absorption can be radically different depending on whether the protein is raw or not.
you seem to have glossed right over ozone which is one of the the best therapies in almost any case of toxicity.
i would also be wary of over-thinking the whole vitamin maze. it can be very seductive at first to think that you can intellectualize yourself out of this mess by making a gigantic flowchart of which vitamins do what, but the body just doesn't work that way. perhaps stop all of your vitamins for a little while and get back to basics, you seem to have a good handle of what diet works for you.
somewhere in this post you said you were thin?
from an ayurvedic perspective, if you are thin or too thin this indicates a vata imbalance. in this case raw vegetables are about the worst thing you can do. warm, cooked, salty and oily foods are indicated in this case, but i am not sure about your dosha.
i am not going to prod you to do liver flushes, but my experience was that taking
Liver Cleansing herbs was sort of like pissing on a forest fire compared to the flushes... flushes are a completely different order of magnitude.
accutane is known to cause liver damage, so i would concentrate there first. it seems to me this was the sequence of events for you and the possible adrenal issues are sequelae arising from the initial damage.
if you are strong enough,
The Master Cleanse might be a good route for you too.