Hydrocortisone and chronic fatigue syndrome

Abstract

Anthony Cleare and colleagues (Feb 6, p 455)1Cleare AJ Heap E Malhi GD Wessely S O'Keane V Miell J Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial.Lancet. 1999; 353: 455-458Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar report that low-dose hydrocortisone proved both effective and safe in reducing degree of disability due to chronic fatigue syndrome (CFS). Nevertheless, rather surprisingly, they state that “we would not recommend the widespread use of hydrocortisone as a therapy strategy”. Such a statement, along with their repeated advocacy of cognitive behavioural therapy, might betray their reluctance to admit that CFS, contrary to previous tenets,2EditorialFrustrating survey of chronic fatigue.Lancet. 1996; 348: 971Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar has more to do with endocrinology than with psychiatry.3Baschetti R. Investigations of hydrocortisone and fludrocortisone in the treatment of chronic fatigue syndrome. J Clin Endocrinol Metab (in press).Google Scholar That reluctance is also revealed by their ill-concealed espousal of Leese and colleagues' idea4Leese G Chattington P Fraser W Vora J Edwards R Williams G Short-term night-shift working mimics the pituitary-adrenocortical dysfunction in chronic fatigue syndrome.J Clin Endocrinol Metab. 1996; 81: 1867-1870Crossref PubMed Scopus (68) Google Scholar that the hypocortisolism of CFS patients “may be merely the consequence of disrupted sleep and social routine”. This view, however, is patently untenable. Although night-shift working may well mimic the pituitary-adrenocortical dysfunction seen in CFS,4Leese G Chattington P Fraser W Vora J Edwards R Williams G Short-term night-shift working mimics the pituitary-adrenocortical dysfunction in chronic fatigue syndrome.J Clin Endocrinol Metab. 1996; 81: 1867-1870Crossref PubMed Scopus (68) Google Scholar it is far from causing all the physical symptoms and neuropsychological abnormalities that affect people with CFS. Conversely, CFS shares 36 features with Addison's disease,3Baschetti R. Investigations of hydrocortisone and fludrocortisone in the treatment of chronic fatigue syndrome. J Clin Endocrinol Metab (in press).Google Scholar including all those symptoms and abnormalities.5Baschetti R Similarity of symptoms in chronic fatigue syndrome and Addison's disease.Eur J Clin Invest. 1997; 27: 1061Crossref PubMed Google Scholar This fact clearly suggests that the hypocortisolism of CFS patients is not due to their disrupted sleep. This sleep pattern, on the contrary, is merely a well recognised consequence of adrenal insuficiency, as in the case of Addison's disease.5Baschetti R Similarity of symptoms in chronic fatigue syndrome and Addison's disease.Eur J Clin Invest. 1997; 27: 1061Crossref PubMed Google Scholar In view of the astounding similarity between CFS and Addison's disease,3Baschetti R. Investigations of hydrocortisone and fludrocortisone in the treatment of chronic fatigue syndrome. J Clin Endocrinol Metab (in press).Google Scholar, 5Baschetti R Similarity of symptoms in chronic fatigue syndrome and Addison's disease.Eur J Clin Invest. 1997; 27: 1061Crossref PubMed Google Scholar Cleare and colleagues should assess whether low doses of both hydrocortisone and fludrocortisone, the two steroids that constitute the standard therapy for Addison's disease,3Baschetti R. Investigations of hydrocortisone and fludrocortisone in the treatment of chronic fatigue syndrome. J Clin Endocrinol Metab (in press).Google Scholar could also benefit CFS patients. Encouragingly, fludrocortisone already lessens these patients' complaints.3Baschetti R. Investigations of hydrocortisone and fludrocortisone in the treatment of chronic fatigue syndrome. J Clin Endocrinol Metab (in press).Google Scholar Hydrocortisone and chronic fatigue syndromeAuthors' reply Full-Text PDF