Low‐Dose Hydrocortisone for Treatment of Chronic Fatigue Syndrome: A Randomized Controlled Trial

McKenzie, Robin; O'Fallon, Ann; Dale, Janet K.; Demitrack, Mark A.; Sharma, Garima; Deloria, Maria A.; Garcı́a-Borreguero, Diego; Blackwelder, William C.; Straus, Stephen E.

doi:10.1097/00004583-199905000-00037

Cited by 39 publications

(52 citation statements)

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“…It has previously been shown that vital exhaustion, a syndrome of unusual fatigue and loss of energy, increased irritability, and depressive symptoms, increases risk of acute myocardial infarction and other manifestations of coronary heart disease [22][23][24] Fatigue in association with other diseases and conditions is treated many different ways, including cognitive behavioral therapy, hydrocortisone, diaminopyrimidine, and psychotropic drugs. 14,[25][26][27] However, in different diseases or medical conditions, different mechanisms probably cause the fatigue, and specific treatments are needed. Clinical trials to find an effective treatment for patients with poststroke fatigue are warranted.…”

Section: Discussionmentioning

confidence: 99%

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Poststroke Fatigue

Glader

Stegmayr

Asplund

2002

Stroke

374

222

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Background and Purpose-Fatigue is common among stroke patients. This study determined the prevalence of fatigue among long-term survivors after stroke and what impact fatigue had on various aspects of daily life and on survival. Methods-This study was based on Riks-Stroke, a hospital-based national register for quality assessment of acute stroke events in Sweden. During the first 6 months of 1997, 8194 patients were registered in Riks-Stroke, and 5189 were still alive 2 years after the stroke. They were followed up by a mail questionnaire, to which 4023 (79%) responded. Patients who reported that they always felt depressed were excluded. Results-To the question, "Do you feel tired?" 366 (10.0%) of the patients answered that they always felt tired, and an additional 1070 (29.2%) were often tired. Patients who always felt tired were on average older than the rest of the study population (74.5 versus 71.5 years, PϽ0.001); therefore, all subsequent analyses were age adjusted. Fatigue was an independent predictor for having to move into an institutional setting after stroke. Fatigue was also an independent predictor for being dependent in primary activities of daily living functions. Three years after stroke, patients with fatigue also had a higher case fatality rate. Conclusions-Fatigue is frequent and often severe, even late after stroke. It is associated with profound deterioration of several aspects of everyday life and with higher case fatality, but it usually receives little attention by healthcare professionals. Intervention studies are needed.

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Section: Discussionmentioning

confidence: 99%

“…Some scales are applicable for several types of fatigue, and some scales measure fatigue caused by a specific disease. [11][12][13][14][15] No scale has yet been developed specifically for poststroke fatigue. Most studies use multidimensional self-estimation questionnaires to measure poststroke fatigue.…”

mentioning

confidence: 99%

Poststroke Fatigue

Glader

Stegmayr

Asplund

2002

Stroke

374

222

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“…In the first study, 70 patients were randomized to receive either active (13 mg/m 2 of body surface area at 8 a.m. and 3 mg/m 2 at 2 p.m.) or placebo treatment for 3 months [81] . There was a moderate but significant benefit of hydrocortisone on a global health scale, but not on other more specific measures of fatigue or disability.…”

Section: Hydrocortisone Replacement Therapymentioning

confidence: 99%

Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome

Eede

Moorkens

Houdenhove³

et al. 2007

Neuropsychobiology

108

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There is evidence for a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis in a proportion of the patients with chronic fatigue syndrome (CFS), despite the negative studies and methodological difficulties. In this review, we focus on challenge studies and on the role of the HPA axis in the pathogenesis of CFS. Mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids are the main findings. Several underlying mechanisms have been proposed. Currently, it is a matter of debate whether these disturbances have a primary role in the pathogenesis of CFS. However, even if the HPA axis dysfunctions are secondary to other factors, they are probably a relevant factor in symptom propagation in CFS.

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“…This analysis showed that prior-day symptoms were not related to waking levels of cortisol, but same-day symptoms were; therefore, the likely causal direction of this effect was from low cortisol levels to greater fatigue and physical symptoms. As Adam et al point out, it remains to be seen whether this effect extends to clinical levels of fatigue or symptoms, though some support has been found in clinical trials with chronic fatigue patients, where the administration of glucocorticoids produced short-term alleviation of fatigue symptoms (Cleare et al, 1999;McKenzie et al, 1998). The effect of waking cortisol on subsequent physical symptoms highlights the significance of cortisol for health outcomes at the daily level.…”

Section: Introductionmentioning

confidence: 99%

Exploring day-to-day dynamics of daily stressor appraisals, physical symptoms and the cortisol awakening response

Gartland

O’Connor

Lawton

et al. 2014

Psychoneuroendocrinology

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Stress is associated with the secretion of cortisol throughout the day, but less is known about the dynamic effects of stress on the cortisol awakening response (CAR). More widely, knowledge of the causal factors and functions of the CAR are also not fully understood. This study explored: (1) the effects of daily stressors on the next day CAR and; (2) the effects of the CAR on same day physical and affective outcomes. Sixty-four participants completed a daily diary, reporting on the occurrence of daily stressors and stress appraisals, physical symptoms, and affect. Cortisol was measured at 0, 15, 30, and 45 minutes after awakening to provide measures of the CAR on 3 consecutive work days. Stress appraisal was found to negatively predict the CAR, such that where stressors were appraised as more stressful (where perceived demands exceeded resources), the CAR increased less the following morning. Furthermore, the CAR significantly predicted same-day physical symptoms such that a lower CAR was associated with more physical symptoms. This study provides evidence for a pathway through which daily stressors may influence physical wellbeing, and highlights the importance of appraisals for future stress-based cortisol research.

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Low‐Dose Hydrocortisone for Treatment of Chronic Fatigue Syndrome: A Randomized Controlled Trial

Cited by 39 publications

References 0 publications

Poststroke Fatigue

Poststroke Fatigue

Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome

Exploring day-to-day dynamics of daily stressor appraisals, physical symptoms and the cortisol awakening response

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