Similarity of symptoms in chronic fatigue syndrome and Addison's disease

Attenuated Morning Salivary Cortisol Concentrations in a Population-Based Study of Persons with Chronic Fatigue Syndrome and Well Controls

“…Reduced adrenal capacity and subsequent reduced availability of cortisol might be a permissive factor for increased activation of the immune system, which is known to be constrained by cortisol. Indeed, Addison's disease, a condition characterized by glucocorticoid insufficiency and increased immune activity, shares many symptoms with CFS (43). Furthermore, it has previously been shown that administration of the cytokine IL-6 during a hypocortisolemic state causes symptoms of CFS (44).…”

Chronic fatigue syndrome: a form of Addison’s disease

“…In fact, reduction in adrenal gland size [7], antibodies against the adrenal gland [8] and respiratory muscle dysfunction [9], besides being present in CFS [7–9], have also been found in Addison’s disease [10–12]. In view of the 39 features that CFS shares with Addison’s disease [3–12] (see Table 1), which constitute a similarity between two distinctly named diseases that is probably unequalled in the medical literature, it seems arguable that CFS should practically be viewed as a form of Addison’s disease [13]. One could object that CFS patients, unlike Addisonian subjects, do not display hyperpigmentation or basal hypocortisolaemia.…”

“…Substantially, all the symptoms listed in both the original [15] and the revised [16] case definition of CFS can also be found in Addison’s disease [3–6], which clearly suggests that those symptoms merely reflect the adrenal insufficiency (inadequate production of both glucocorticoid and mineralocorticoid hormones) that CFS patients share with Addisonian subjects [13]. Of note, the ‘hotly debated’ psychiatric symptoms of CFS patients, instead of demonstrating that CFS is a psychiatric disorder, are solely due to their adrenal insufficiency, those symptoms being also present in Addison’s disease [2], a purely physical condition.…”

“…Moreover, the adrenal insufficiency of CFS patients may also explain many abnormalities mentioned by Evengård et al . [1], such as reactivation of latent infections [6], chronic immune dysregulation [6], depressed function of natural killer cells [4] and neurally mediated hypotension [17]. Finally, there is no reason to exclude that other abnormalities mentioned by Evengård et al .…”

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

“…The failure of both the English and Australian reports to mention other important endocrine abnormalities of CFS represents a serious omission, especially because Addison's disease, a classic endocrine disorder, is the medical condition that resembles CFS far more closely than all the ‘overlapping diagnoses’[2] discussed in the Australian guidelines. 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].…”