The role of hypocortisolism in chronic fatigue syndrome

[MikeJackmin]

Sanne L. Nijhofa, Juliette M.T.M. Ruttenb, Cuno S.P.M. Uiterwaalc,
Gijs Bleijenbergd, Jan L.L. Kimpena, Elise M. van de Puttea
Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands.

Background

There is accumulating evidence of hypothalamic-pituitary-adrenal (HPA) axis hypofunction in chronic fatigue syndrome (CFS). However, knowledge of this hypofunction has so far come exclusively from research in adulthood, and its clinical significance remains unclear. The objective of the current study was to assess the role of the HPA-axis in adolescent CFS and recovery from adolescent CFS.

Method

Before treatment, we compared the salivary cortisol awakening response of 108 diagnosed adolescent CFS patients with that of a reference group of 38 healthy peers. Salivary cortisol awakening response was measured again after 6 months of treatment in CFS patients.

Results

Pre-treatment salivary cortisol levels were significantly lower in CFS-patients than in healthy controls. After treatment recovered patients had a significant rise in salivary cortisol output attaining normalization, whereas non-recovered patients improved slightly, but not significantly. The hypocortisolism found in CFS-patients was significantly correlated to the amount of sleep. Logistic regression analysis showed that an increase of one standard deviation in the difference between pre- and post-treatment salivary cortisol awakening response was associated with a 93% higher odds of recovery (adjusted OR 1.93 (1.18 to 3.17), p = 0.009). Pre-treatment salivary cortisol did not predict recovery.

Conclusions

Hypocortisolism is associated with adolescent CFS. It is not pre-treatment cortisol but its change to normalization that is associated with treatment success. We suggest that this finding may have clinical implications regarding the adaptation of future treatment strategies.

http://www.sciencedirect.com/science/article/pii/S0306453014000420?np=y

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I wonder what treatment they are referring to here? I also wonder how cortisol levels would compare between CFS patients and fatigued, non-CFS controls.

 

[Bob]

Hi Mike, thanks for posting.

You've quoted the surnames incorrectly, but these authors are prolific CBT proponents, so I imaging that the 'treatment' is CBT. The paper is probably an attempt to justify CBT for CFS patients. Without reading the full paper it's impossible to know if it is methodologically rigorous or flawed.

These are the correct details:

The role of hypocortisolism in chronic fatigue syndrome
Sanne L. Nijhof, Juliette M.T.M. Rutten, Cuno S.P.M. Uiterwaal, Gijs Bleijenberg, Jan L.L. Kimpen, Elise M. van de Putte
April 2014
Psychoneuroendocrinology. 42:199-206.
Available online 30 January 2014
http://www.sciencedirect.com/science/article/pii/S0306453014000420

 

[adreno]

The treatment was computerbased CBT (FITNET).

 

[MikeJackmin]

Oops, sorry about the names. Cut-and-paste was not my friend today.

 

[Bob]

FITNET was found to be ineffective at treating CFS patients at 2.5 year follow-up, so I assume that this paper measured cortisol at 6 months, not 2.5 years! (There were some positive results in the FITNET trial at 6 months.)

 

[Valentijn]

FITNET was found to be ineffective at treating CFS patients at 2.5 year follow-up, so I assume that this paper measured cortisol at 6 months, not 2.5 years! (There were some positive results in the FITNET trial at 6 months.)

I think it's also likely that the recovered and non-recovered patients had very different medical problems.

 

[Grigor]

I was just reading into this. Crawley also uses this as her argument for FITNET. This sounds like an objective measure. Strange they didn't use it in FITNET itself.
Anyways but is there a good explanation for the positive results?