Chronic fatigue syndrome and fibromyalgia are two diagnosis that remain difficult discern, both to patients and physicians. Both produce nonspecific symptoms of fatigue and pain, with no clear underlying cause. They are a diagnosis of exclusion, given when all other possibilities have been ruled out.

Many people believe that chronic fatigue and fibromyalgia result from an underlying psychiatric illness, based on the associated of anxiety and depression. Still others think an underlying autoimmune disorder or viral infection may be to blame.

A recent report published by a leading expert in the treatment of chronic fatigue syndrome states that an underlying endocrine disorder may be partly to blame. Based on a literature review of more than 50 published studies, it was determined that the majority of patients with these disorders have a dysfunctional hypothalamic-pituitary-adrenal (HPA) system. The HPA system is a complex pathway involving hormones released from the brain that promote the production of cortisol by the adrenal glands. Cortisol has a huge range of effects on a variety of body systems, including metabolism, inflammation and mental function.

The review supported the theory that problems with the hypothalamic or pituitary gland, both located in the brain, result in decreased production of cortisol by the adrenal glands. More importantly, treatment with a low dose oral cortisol medication resulted in improvement in the majority of patients. A further study found 94% of patients to show improvement by their fourth office visit, with the majority reporting a doubling in their energy level and sense of well-being.

There is currently no good treatment for chronic fatigue syndrome or fibromyalgia. A variety of approaches, including pain medication, anti-anxiety medication and counseling may be attempted. Still, the majority of patients are left with significant fatigue and pain that prevent normal daily activities. Administration of low-dose oral cortisol is advocated by some to be a low risk and potentially useful tool in the treatment of these complex and poorly understood conditions.

Reference

Holtorf, K. (2008). Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). Journal of Chronic Fatigue Syndrome, 14(3), 59-88. DOI: 10.1300/J092v14n03_06