CHICAGO, IL -- Sept. 22, 1998 -- Low-dose
hydrocortisone may be an effective treatment for chronic fatigue
syndrome (CFS), but patients experience a potentially-dangerous side effect,
according to an article in the Sept. 23/30 issue of The Journal of
the American Medical association.
Robin McKenzie, M.D., of the National Institutes of Health
in Bethesda, MD., and colleagues studied the effect of low-dose hydrocortisone
as a treatment for CFS. Participants who received low-dose hydrocortisone
reported feeling better than participants who only received a placebo treatment.
The study used a wellness score that rated overall
health using a scale with zero representing the worst the participant had
ever felt and 100 representing the best they had ever felt.
"The percentages of patients recording improvement
of at least five, 10 or 15 points on the wellness scale were greater
for hydrocortisone than placebo recipients [five points, 53 percent versus
29 percent; 10 points, 33 percent versus 14 percent; and 15 points, 20
percent versus six percent]," the researchers said. "The mean improvement
on treatment in the hydrocortisone group was 6.3 points, being higher than
the mean improvement of 1.7 points for the placebo
group."
Although these results were promising, the study
also found that patients who received hydrocortisone experienced significant
adrenal suppression. It was previously believed that low doses of corticosteroids
were relatively safe and would not cause this type of suppression.
"Although steps were taken to avert serious or potentially
life-threatening adrenal insufficiency in the face of emergent stress,
the fact that it could happen with less cautious widespread use precludes
the present
regimen of hydrocortisone or comparable doses of other
systemic corticosteroids as acceptable choices for the prolonged
treatment of chronic fatigue syndrome," they said.
The researchers have been exploring the possible
connection between the endocrine system (especially the hypothalamic-pituitary
adrenal axis) and CFS. Corticosteroid hormones are an important part of
making nutrients and energy available to the body. The adrenal glands are
the source of natural production of corticosteroid hormones, such as cortisol,
commonly known as hydrocortisone.
The researchers tested the amount of hydrocortisone
in patients with CFS and found that they had on average about 30 percent
less hydrocortisone than healthy controls. This led the researchers to
consider
low-dose supplementation with hydrocortisone to possibly
correct the imbalance.
The researchers used the more complex 1988 Centers
for Disease Control and Prevention criteria todefine the cases to be included
in the study. The 1988 case definition requires debilitating fatigue and
eight or more of 11 signs and symptoms occurring for at least six months.
The patients also met the 1994 CDC criteria. The eight symptoms are memory
or concentration complaints, sore throat, tender lymph nodes, muscle pain,
multi-joint pain, a new pattern of headaches, unrefreshing sleep and malaise
after exertion that lasts more than 24 hours.
The researchers conclude that though this is the
first study, to their knowledge, to show an improvement in CFS due to a
drug treatment, the low-dose hydrocortisone treatment probably is not viable
in a clinical setting.
"What little improvement might be attributable to hydrocortisone
treatment was achieved at the expense of significant adrenal suppression,"
they explained.
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