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

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

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7 thoughts on “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”

  1. jsellie says:

    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.

    1. giri says:

      I been having fibro for 18 years. i don’t even have energy to fight or write. tahnk you take care.
      Giri

    2. jsellie says:

      Dear Giri,

      I am so very sorry for you! I have had this now for almost 5 years and it has ruined my life. However, I have learned much more than I could ever think I would. I DO understand how the pain, frustration and exhaustion take so very much out of you; which is why I HAD to study and study and read and research…to better understand this horrible thing that has attacked so many of us…yet the doctors keep telling us it is in “our heads”. Check out the two newest drugs for Fibro: Cymbalta and Lyrica. BOTH are nothing but antidepressants. There they go again…let’s throw some more drugs at ’em till they are all so mind altered they just dissapear.

      I tried to kill myself on Cymbalta, and I wrote a message to this very website to let others know how horrible my experience was on it. Coming off of it was even worse.

      I will NOT be defeated in this fight, although, I have to tell you, there are many, many days when I cry and wonder, “Why ME?”. I am so exhausted and in so much pain. The flare ups last for weeks,sometimes months at a time. My doctor, understanding that I have tried EVERY available treatment out there…. alternative, drugs, vitamins, shots, herbs, etc., now has me on narcotics to try and break the cycle of pain. The more pain you are in, the more stress your body endures, and the more pain you will be in. It is a vicious, horrible cycle.

      Thank the Lord I found myself a wonderful rheumatologist who does understand that EVERY PERSON who has this illness is different, and not everyone is going to react to medications in the same way.

      I will pray for you that you will soon have a remission and will learn how to best take care of you. The first key is to get a lot of rest! Try to go on the Diagnostics Website(from Canary Club.org ) and find yourself a great doctor who REALLY cares and will take care of you the way you deserve to be taken care of. It seems that most of this country could care less how well we are taken care of, except for our families and loved ones.

      Soft hugs,
      jsellie

    3. giri says:

      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

    4. giri says:

      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

    5. Kim1998 says:

      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

  2. jsellie says:

    Hi Giri,

    I was first evaluated by a 24 hr. saliva test, and then I found an integrative doctor who treats people by their symptoms…and who validates the usage of the saliva tests. He has me on compounded cortisol ( 15 mg. per day ) and Pregenelone ( 20 mg. per day.) He also has me on Seriphos for my high nightime cortisol. I get all of these things from him.

    My recommendation to you is to go to canaryclub.org and register. Then, click on Diagnostechs Lab. Get the 24 hour test….you can find a doctor in your state by going into Diagnostechs website and they list doctors who use this method of treatment.

    You may need Cytomel along with your Armour..if you are taking Synthroid, I can tell you, it is a TERRIBLE drug. It has had so many recalls it is not funny. It made me suicidal. And, it does not provide all of the thryroid hormones your body needs. Please, do this for yourself. You will be amazed at what you will learn. We MUST take responsibility for our own health care, and stand up for what is right FOR US,as individuals, because the traditional doctors just mostly don’t have a clue.

    If you are this exhausted during the day, I just bet that your cortisol levels are WAY down and that you are in adrenal fatigue. Please keep me updated on how it goes for you, and my prayers are with you! Please take care of yourself!

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