A new review of adrenal dysfunction in chronic fatigue syndrome and fibromyalgia patients suggests that low doses of cortisol may be beneficial to many.
The review which is published in the Journal of Chronic Fatigue Syndrome is the work of Californian physician, Kent Holtorf, MD. Dr. Holtorf is medical director of the Holtorf Medical Group Center for Endocrine, Neurological and Infection related illness and is an expert in the treatment of chronic fatigue syndrome (CFS) and fibromyalgia, having developed protocols for Fibromyalgia and Fatigue Centers and other specialist clinics throughout the US.
Abnormal adrenal function has been the focus of numerous studies into CFS and fibromyalgia. It is thought that dysfunction of the hypothalamus and pituitary gland in the brain are the cause of the adrenal problems since they are responsible for regulating the functions of the adrenal glands. Together, the hypothalamus, pituitary glands, and adrenal glands form the hypothalamic-pituitary-adrenal (HPA) axis. It is the HPA axis that regulates the body's response to stress. Deficiences in the way the HPA axis works can lead to symptoms such as poor stress tolerance and fatigue.
Dr. Holtorf undetrook an extensive review of more than 50 such studies that assessed adrenal function in CFS and fibromyalgia patients. As expected he found that the majority of patients in the studies displayed abnormal adrenal function as a result of hypothalamus and pituitary gland dysfunction. The review also revealed that in many instances patients responded to treatments designed to correct this dysfunction. The analysis demonstrated that patients given low doses of cortisol (a major adrenal hormone) as part of a comprehensive treatment plan experienced significant improvements in their symptoms.
"My review of existing studies suggests that a treatment protocol of early administration of cortisol may help improve and reduce the symptoms of chronic fatigue syndrome and fibromyalgia," said Dr. Holtorf.
He further explains that treating the known causes of CFS and fibromyalgia (such as adrenal dysfunction) can lead to significant improvement in symptoms and overall quality of life in people suffering from these illnesses.
In addition to the review of published research Dr. Holtorf reported the results of observational studies at his own clinic and at other specialist CFS and fibromyalgia clinics.
Dr. Holtorf routinely uses low dose cortisol therapy as part of a comprehensive treatment plan for patients at his clinic. For the study he followed the progress of 500 patients whom he treated with cortisol. In the Journal of Chronic Fatigue Syndrome paper he reports that 94% of patients showed improvement by the fourth visit with 75% reporting significant improvement. Patients also experienced a doubling of their energy levels and sense of well-being by the fourth visit.
These findings were then confirmed by the cumulative observations of 40 independent physicians who in total treated over 5000 CFS and fibromyalgia patients with cortisol.
From his review of the research and his own experiences (and those of other physicians), Dr. Holtorf believes that cortisol doses of 5-15mg a day have a low risk of side-effects while having the potential to significantly improve the lives of CFS and fibromyalgia patients.
He concludes that: "Cortisol treatment carries significantly less risk and a greater potential for benefit than treatments considered to be the standard of care for both conditions."
A number of other CFS and fibromyalgia specialists also routinely use low dose adrenal hormones with their patients and report very positive results but they are currently considered outside of the mainstream.
According to medical experts interviewed by WebMD, while there is consensus that adrenal dysfunction is a significant feature of CFS and fibromyalgia, the use of low dose cortisol (and DHEA - another adrenal hormone) remains controversial. Some question the effectiveness and safety of the treatment while others point out that while adrenal dysfunction is common some studies have actually shown high levels of hormones rather than the low levels which may be aided by low dose replacement therapy. The expense and difficulty of testing HPA-axis function in individual patients also makes tailoring treatment to specific abnormalities difficult.
Never the less the findings of Dr. Holtorf and others certainly suggest that adrenal dysfunction is an important target for treatment in these difficult to treat illnesses.