Neuroendocrine correlates of Chronic Fatigue Syndrome (CFS): a brief review

Chronic fatigue syndrome remains one of the more perplexing
syndromes in contemporary clinical medicine. One approach to
understanding this condition has been to acknowledge its
similarities to other disorders of clearer pathophysiology. In
this review, a rationale for the study of neuroendocrine
correlates of chronic fatigue syndrome is presented, based in
part on the clinical observation that asthenic or fatigue
states share many of the somatic symptom characteristics seen
in recognized endocrine disorders. Of additional interest is
the observation that psychological symptoms, particularly
disturbances in mood and anxiety, are equally prominent in
this condition. At this time, several reports have provided
replicated evidence of disruptions in the integrity of the
hypothalamic-pituitary-adrenal axis in patients with chronic
fatigue syndrome.

It is notable that the pattern of the alteration in the stress
response apparatus is not reminiscent of the well-understood
hypercortisolism of melancholic depression but, rather, suggests
a sustained inactivation of central nervous system components
of this system. Recent work also implicates alterations in central
serotonergic tone in the overall pathophysiology of this finding.
The implications of these observations are far from clear, but they
highlight the fact that, though chronic fatigue syndrome overlaps with
the well-described illness category of major depression, these
are not identical clinical conditions.

MCM: From 1994 AACFS meeting in Ft. Lauderdale

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