Side effects rule against hydrocortisone

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Low-dose hydrocortisone may be an effective treatment for CFS, but it has the potentially dangerous side effect of suppressing the adrenal system. That was the conclusion of a research team at the National Institutes of Health. While significantly more patients on the hydrocortisone treatment than placebo patients reported feeling somewhat better, more than one-third of the patients in the treatment group experienced potentially dangerous adrenal suppression.

The researchers have been exploring the possible connection between the endocrine system, particularly the hypothalamic-pituitary adrenal (HPA) axis, and CFS. Corticosteroid hormones produced by the adrenal glands play an important role in making nutrients and energy available to the body. In an earlier study by some of the same researchers, including Dr. Mark Demitrack, CFS patients were found to have 30% less cortisol than healthy controls, so researchers proposed the low-dose supplementation. Preliminary results of the study were reported in 1996.

In an accompanying editorial, David H.P. Streeten, PhD, of the State University of New York Health Science Center in Syracuse, said the study adds “interesting new data” to the mystery of the pathogenesis of CFS. He discussed research (including his own) that suggests orthostatic hypotension and variations in blood volume might play a role, while other data have suggested an infectious agent as the culprit. “Perhaps the most reasonable conclusion from the evidence to date is that chronic fatigue may have a variety of causes and pathogeneses.

In patients with chronic fatigue syndrome, the cause might include dysfunction of the hypothalamic-pituitary adrenal axis and hypocortisolism [underproduction of hydrocortisone] or…an infectious agent,” Dr. Streeton wrote. He called for further studies “to unravel the pathophysiologic mechanism of chronic fatigue and to find therapies to effectively ameliorate the debilitating symptoms that accompany this complex disorder”

McKenzie, R. et. al., (1998). Low-dose hydrocortisone for treatment of chronic fatigue syndrome. Journal of the American Medical Association, 280, 1061-1066.

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