Hypothalamicpituitaryadrenal axis in chronic fatigue syndrome
Djordje Marina1, Svetlana Jelic1, Nada Kostic1, Zorica Caparevic1, Bozo Trbojevic2, Biljana Beleslin2, Sanja Ilic1 & Milos Zarkovic2
Background/objectives: The aim of the study was to assess hypothalamicpituitaryadrenal (HPA) axis in patients with chronic fatigue syndrome (CFS).
Design and methods: Twenty-three consecutive patients who fulfilled centers for disease control (CDC) criteria for CFS and twenty healthy controls were included in the study. Low dose ACTH test (1mcg of synthetic adrenocorticotropic hormone Synacthen) and insulin tolerance test (ITT) were done and blood cortisol was measured. Data are presented as median with 95 percentile range (2.597.5 percentile). Maximum cortisol level was 640.1 mmol/l (338.9920.1 mmol/l) in CFS patients and 701.2 mmol/l (469.81233 mmol/l) in healthy control group.
Results: Dose of ACTH did not differ between patients and controls given in ng/kg of body weight or ng/m2 of body area. Basal cortisol concentrations did not differ between CFS patients and controls. Maximum cortisol response in ACTH test was significantly lower in CFS versus control group. Maximum cortisol response and area under curve in ITT was significantly lower in CFS patients versus control group.
Conclusions: These results indicate disturbance in cortex of adrenal gland in patients with chronic fatigue syndrome. From our data we cannot conclude whether there are some other disturbances in HPA axis.