Phosphate diabetes in patients with Chronic Fatigue Syndrome (CFS)

Phosphate depletion is associated with neuromuscular dysfunction due
to changes in mitochondrial respiration that result in a
defect of intracellular oxidative metabolism. Phosphate
diabetes causes phosphate depletion due to abnormal renal
re-absorption of phosphate be the proximal renal tubule. Most
of the symptoms presented by patients with phosphate diabetes
such as myalgia, fatigue and mild depression, are also common
in patients with chronic fatigue syndrome, but this
differential diagnosis has not been considered. We
investigated the possible association between chronic fatigue
syndrome and phosphate diabetes in 87 patients who fulfilled
the criteria for chronic fatigue syndrome. Control subjects
were 37 volunteers, who explicitly denied fatigue and chronic
illness on a screening questionnaire. Re-absorption of
phosphate by the proximal renal tubule, phosphate clearance
and renal threshold phosphate concentration were the main
outcome measures in both groups. Of the 87 patients with
chronic fatigue syndrome, nine also fulfilled the diagnostic
criteria for phosphate diabetes. In conclusion, we report a
previously undefined relationship between chronic fatigue
syndrome and phosphate diabetes. Phosphate diabetes should be
considered in differential diagnosis with chronic fatigue
syndrome; further studies are needed to investigate the
incidence of phosphate diabetes in patients with chronic
fatigue syndrome and the possible beneficial effect of vitamin
D and oral phosphate supplements.

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