Chronic fatigue syndrome: a form of Addison’s disease

Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome

“…As to the link between hypocortisolism and symptomatology, treatment trials have provided modest evidence that some patients experience an alleviation of symptoms when hypocortisolism is reversed (see the section below). Given the link in conditions such as Addison's disease between low cortisol and symptoms similar to those seen in CFS [80] , it might be argued that, even if HPA axis disturbances are secondary to other factors, low levels of cortisol in CFS could be a factor relevant in symptom propagation and perpetuation [37] .…”

Chronic fatigue syndrome, exercise, cortisol and lymphadenopathy

“…Unfortunately, because of the misleading coexistence of quite different diagnostic criteria for CFS [1], it is difficult to predict the patients with CFS who are more likely to have hypocortisolism and which would worsen with exercise. However, it is arguable that the presence or absence of lymphadenopathy [8], which is a sign of hypocortisolism [6, 9] and is one of the 43 clinical features that CFS shares with Addison's disease [10–12], could reliably discriminate CFS patients who may worsen with exercise from those who may improve with it. Indeed, lymphadenopathy, unlike other symptoms of CFS [11, 12], many of which are non‐specific and can also be found in depression and other affective disorders [11, 12], is far from being common in physical diseases and is absent in psychiatric conditions.…”

Chronic fatigue syndrome: an endocrine disease off limits for endocrinologists?

“…Twenty clinical features shared by CFS and Addison's disease had already been listed in this journal in 1997 [3]. There is evidence now that those conditions share 42 clinical features [4–7], including abrupt onset, over‐representation of middle‐aged women, and all the signs and symptoms listed in the original [8] and in the revised [9] criteria for CFS, namely, chronic fatigue, postexertional debilitation, weakness, low‐grade fever, enlarged lymph nodes, muscular aches, joint pains, flu‐like malaise, sore throat, headaches and disturbed sleep [4,5].…”

“…Chronic fatigue syndrome and Addison's disease also share all the neuropsychological complaints listed in the criteria for CFS, namely, mental confusion, inability to concentrate, forgetfulness, irritability and depressed mood [5]. As has been pointed out, ‘organic mental disorders due to Addison's disease may resemble other psychiatric illnesses’[10].…”

“…The 42 clinical features that CFS shares with a classic endocrine disorder [4–7] suggest that at least one endocrinologist should be included in any future working group aimed at developing an unbiased and reliable report on CFS. In this respect, it is worth noting that in the 133 pages of the English and Australian reports combined there is not a single word about the similarity between CFS and Addison's disease, whereas this similarity is not ignored in the more balanced eight pages that form a recent American report [30], which represents the consensus of a multidisciplinary panel of experts comprising ‘researchers and practitioners in the fields of endocrinology’[30].…”