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Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) - Source: Journal of Chronic Fatigue Syndrome, vol 14 #3, 2007

  [ 114 votes ]   [ 7 Comments ]
By Kent Holtorf, MD • www.ProHealth.com • November 8, 2007


There is controversy regarding the incidence and significance of hypothalamic-pituitaryadrenal (HPA) axis dysfunction in Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). Studies that utilize central acting stimulation tests, including CRH, IST, d-fenfluramine, ipsapirone, IL-6 and metyrapone testing, have demonstrated that HPA axis dysfunction of central origin is present in a majority of these patients.

However, ACTH stimulation tests and baseline cortisol testing lack the sensitivity to detect this central dysfunction and have resulted in controversy and confusion regarding the incidence of HPA axis dysfunction in these conditions and the appropriateness of treatment.

While both CFS and FM patients are shown to have central HPA dysfunction, the dysfunction in CFS appears to be at the pituitaryhypothalamic level while the dysfunction in FM is more related to dysfunction at the hypothalamic and supra-hypothalamic levels.

Because treatment with low physiologic doses of cortisol (< 15 mg) has been shown to be safe and effective and routine dynamic ACTH testing does not appear to have significant diagnostic sensitivity, it is reasonable to give a therapeutic trial of physiologic doses of cortisol to the majority of patients with CFS and FM, especially to those who have symptoms that are consistent with adrenal dysfunction, have low blood pressure, or have baseline cortisol levels in the low or low-normal range.

Source: Journal of Chronic Fatigue Syndrome, vol 14 #3, 2007. (Prepublication) DOI: 10.1300/ , by Holtforf K




Please Discuss This Article:   Post a Comment 

HPA dysfunciton in FM/CFIDS & safe use of cortisol
Posted by: jsellie
Nov 14, 2007
WOW! It is amazing that the CONVENTIONAL doctors are FINALLY figuring this out! I have been on 20 mg. of cortisol for about a year now, when it was determined that my adrenals were just about burned out. HOW WAS THIS FIGURED OUT? I WENT OUTSIDE THE BOX, WHEN THE MYRIAD OF DOCTORS I HAD SEEN HAD NO CLUE AS TO HOW TO TREAT MY VERY SEVERE FM/CFIDS. I STUDIED AND RESEARCHED, AND I GOT THE SALIVA TEST FROM DIAGNOSTICS LAB THROUGH CANARY CLUB; ON THE ADVICE FROM A FRIEND WHO SUFFERS FROM THE SAME ILLNESSES. SHE SEES DOCTORS WHO ARE FOLLOWING DR. BRODA BARNES' PROTOCOL; THAT THYROID MALFUNCTION CAUSES FM. THE TEST SHOWED MY 24 HOUR CORTISOL PATTERN, MY SEX HORMONE DEFICINCIES AND A VERY FINE TUNED DIAGNOSIS OF MY THYROID FUNCTION. IT ALSO SHOWED ME POSITIVE FOR HASHIMOTO'S THYROIDITIS. I WAS A 100% HEALTHY WOMAN UNTIL MY THYROID FINALLY QUIT... I HAVE HASHIMOTO'S THYROIDITIS AND THE CONVENTIONAL DOCTORS ABSOLUTELY REFUSED TO GO OUTSIDE OF THE BOX AND TEST FOR THIS...A SIMPLE BLOOD TEST. THE ENTIRE MATERNAL SIDE OF MY FAMILY HAS HASHI'S. AFTER DEVELOPING HASHI'S, AND SUFFERING THROUGH MANY, MANY MIS-DIAGNOSES, INCLUDING BI-POLAR DISEASE, BEING GIVEN SO MANY, MANY DRUGS THAT ONLY CAUSED ME TO BECOME SICKER, I FINALLY HAD ONE HUGE PART OF THE ANSWER. IT IS A VERY SAD STATE OF AFFAIRS THAT WE, THE PATIENTS, WHO ARE SO VERY ILL, HAVE TO DO OUR OWN THOUSANDS OF HOURS OF RESEARCH IN ORDER TO FIGURE OUT WHAT IS WRONG WITH US. NOW, I FINALLY HAVE A WONDERFUL DOCTOR WHO IS A VERY RESPECTED RHEUMATOLOGIST AND WHO TREATS ME REGARDING MY SYMPTOMS....AND WHO DOES NOT LAUGH AT ME WHEN DISCUSSING THYROID, ADRNENAL FATIGUE AND THEIR OBVIOUS RELATIONSHIP TO FM AND CFIDS, AND HOW IF NOT TREATED, CAN CAUSE HPA FAILURE. I URGE AND BEG, DOCTORS WHO ARE ATTEMPTING TO UNDERSTAND AND TREAT YOUR PATIENTS WITH FM/CFIDS, LISTEN TO YOUR PATIENTS. DO NOT LAUGH AT THEM, DE-MORALIZE THEM BY TELLING THEM THAT YOU ARE THE DOCTOR AND THAT THEY MUST DO WHAT YOU SAY, WITHOUT CHECKING OUT ALL OF THE INFORMATION THAT IS AVAILABLE TO YOU, JUST AS IT IS TO US. I HAVE BECOME 100% DISABLED AND ALMOST DIED BY LISTENING TO "DOCTORS" WHO LAUGHED AT ME AND PRESCRIBED VERY HARMFUL MEDICATIONS TO ME. IS NOT A DOCTOR'S FIRST OATH TO DO NO HARM? WELL, I CANNOT TELL YOU HOW MANY "DOCTORS" TREATMENTS ALMOST KILLED ME, AND HOW MANY TIMES,I, LIKE SO MANY OTHERS WITH THIS SAME ILLNESS, HAVE CONTEMPLATED SUICIDE BECAUSE OF MY FRUSTRATION WITH DOCTORS WHO THINK THEY KNOW IT ALL, AND THE TRUTH IS THAT THEY REALLY KNOW VERY LITTLE.
Reply Reply

 
how true!!! appeciate your e mail
Posted by: giri
Nov 14, 2007
I been having fibro for 18 years. i don't even have energy to fight or write. tahnk you take care. Giri

 

 
throid and cortisol
Posted by: giri
Nov 27, 2007
How do you get your cortisol? I am in same boat of throid hashimoto's. I was unable to handle armour throid, may be because of cortisol not being ok. thanks take care

 

 
HELP for HPA
Posted by: Kim1998
Jan 31, 2012
How are you now? I am having the same problems. Where do I find a doctor to help me with the HPA dysfunction? i am on disability for FM and CFS. I have gained over 50 lbs. and look like I'm on prednisone. I know how that looks because I was on it for ulcerative colitis back in the 80's. I know there is a hormonal problem, but my TSH comes back normal and no one will do further testing on me. They think I'm just fat. I'm so uncomfortable. The only one that feels I have a thyroid or pituitary/adrenal problem is my chiropractor. Who always asks me if I'm takin steroids. I live in Indiana and am very desperate to find someone to help me with the HPA Axix dysfunction. Thank you for feedback as soon as possible. Kim

 


protein digestion
Posted by: giri
Nov 27, 2007
I can’t digest protein with fibro, does anyone has used any enzymes to help them digest food? I am thinking of stanford study for fibro--ie low dose of Naltrexone. thanks for your time giri
Reply Reply
 
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