No inclusive or satisfactory biomedical explanation for
chronic fatigue syndrome (CFS) has as yet been forwarded.
Recent research suggests that a dysregulated
hypothalamic-pituitary-adrenal axis (HPA) may be contributory,
and in particular that there may be diminished forward drive
and adrenal under-stimulation. In this preliminary study we
wished to examine a cohort of CFS patients in whom evidence
for such hypofunctioning was found. Our aim was to establish
whether these patients had altered adrenal gland size.
Patients were recruited from a fatigue clinic. Those who
fulfilled the Centre for Disease Control and Prevention (CDC)
criteria underwent a 1 microgram adrenocorticotropin (ACTH)
stimulation test, a test of adrenal gland functioning.
subjects (five females, three males) with a subnormal response
to this test underwent a computer tomography (CT) adrenal
gland assessment. Measurements were compared with those from a
group of 55 healthy subjects. The right and left adrenal gland
bodies were reduced by over 50% in the CFS subjects indicative
of significant adrenal atrophy in a group of CFS patients with
abnormal endocrine parameters. This is the first study to use
imaging methods to measure adrenal gland size in CFS. It is a
limitation of this study that a selected CFS sample was
employed. A future larger study would optimally employ an
unselected cohort of CFS patients.
This study has implications
not only for the elucidation of CFS pathophysiology, but also
for possible therapeutic strategies.
Scott LV, Teh J, Reznek R, Martin A, Sohaib A, Dinan TG