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Morphological and functional abnormalities of the hypophysis in patients with a diagnosis of CFS or fibromyalgia. An example of misdiagnosis by Belgian chronic fatigue centers

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By Francis Coucke et al. • www.ProHealth.com • June 5, 2013

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Editor's Comment: The hypophysis (hypofyse in Dutch) is commonly known as the pituitary gland. The pituitary is an endocrine gland responsible for a variety of functions, including maintaining homeostasis, regulating growth (through growth hormone - GH), water balance, processing pain, and sex hormone production via signals to the adrenals and thyroid. This study found that 10% of the patients diagnosed with CFS at chronic fatigue clinics in Belgium over the course of a year had underlying primary endocrine disorders: cysts, tumors (adenomas), and a shrunken pituitary (empty sella). All of these are anatomical problems that can be remedied by effective treatments (usually hormone supplementation).

By Francis Coucke et al.

Aim: In consultation, we check a lot of patients who present with diagnoses of FM (fibromyalgia) and chronic fatigue syndrome (CFS). Most of these patients have an underlying diagnosis that causes chronic pain or fatigue. These causes are pathologies not easily detected. Endocrine failure is one of the candidates, with hypophysis dysfunction as a possible candidate.

Methods: During 1 year: from October 11, [year not stated] of 487 patients who presented at consultation, we found 47 cases of morphological and functional hypophysis abnormalities. We used a stress test in patients with clinical complaints and low basal hormones: e.g. low IGF1 or cortisol, combined with morphological abnormalities of the hypophysis.

Results: Forty-seven patients had abnormalities of the hypophysis:

  • Cysts: 6 cases average age 50.8, all female, mean diameter 5.2 mm (from 4 to 8 mm). All are ACTH–cortisol deficient and 1 of them is GH deficient (GHD).
  • Adenomas: 31 cases average age: 42 years, 23 female, 8 males, mean size of 5 mm (from 12 to 3 mm), all are ACTH–cortisol deficient and 11 are also GHD.
  • Empty sella: 12 cases: average age: 53, 25 years, 5 males, 7 females, all deficient in ACTH–cortisol and 8 are GHD.

Conclusion: Patients with a diagnosis of CFS or fibromyalgia should always be checked for underlying chronic diseases. Most immunologic but also endocrine diseases can be underlying, for example, frequently adrenal insufficiency can be detected. A lot of reports also document a low IGF1 and GHD.

Patients with hormone deficiencies should also be checked for other hormone deficiencies. In the case of low hypophysis hormones, single or multiple, the hypophysis has to be functionally and morphologically checked. As opposed to the disappointing general therapy of FM or CFS, a good and efficient therapy can be offered to patients by treating the underlying hormonal deficiencies.

Source: Endocrine Abstracts (2013) 32 P222 | DOI:10.1530/endoabs.32.P222. Francis Coucke, Heidi Lammens, Laurens Coucke & Anne-Birgitte Vogter. METARES, Sint Gillis Was, Belgium.



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Diagnosis
Posted by: IanH
Jun 5, 2013
This is why the diagnosis of exclusion must be evaluated properly. Without the use of biomarkers this muddying of the group causes much confusion in research and treatment. CFS and FM are clearly being used to keep the costs of evaluation down, I suspect with deadly consequences sometimes.

It is time that clinics such as these in Belgium and Britain start using the biological indicators that we already have. While they are not perfect they are a damn site better than the guessing game going on at the moment.
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