Low doses of the steroid hydrocortisone can cause slight improvement in some chronic fatigue syndrome (CFS) symptoms but at the risk of inducing adrenal suppression. This finding, researchers from the National Institute of Allergy and Infectious Diseases (NIAID) claim, precludes the use of hydrocortisone in people with the illness. Their report appears in the September 23/30 issue of The Journal of the American Medical Association.
"The data show that about half the people on placebo and two-thirds of those taking hydrocortisone reported some improvement in well-being," comments Stephen E. Straus, M.D., chief of the Laboratory of Clinical Investigation at NIAID and senior author on the study. "The greater benefit seen in the hydrocortisone group, however, was modest, and there was clear evidence of adrenal suppression by the drug." Twelve of 33 patients on the therapy developed laboratory evidence of adrenal insufficiency. "It was manageable and completely reversible," says Dr. Straus, "but it's the kind of suppression that in the context of minimal improvement afforded by the drug cannot, in our minds, justify using this treatment for CFS.
"Any time that long-term steroid therapy is considered, even at a low dose," adds Dr. Straus, "one needs to be concerned that the treatment itself may suppress the adrenal gland's normal production of steroids, which can lead to serious complications. When suppressed, the adrenal gland can't respond well to sudden stressful events such as a heart attack or an accident."
Hydrocortisone Study Rationale
People with CFS can suffer for years from an array of symptoms, including prolonged, debilitating fatigue, unrefreshing sleep, muscle pains, and memory and concentration problems. Although painkillers, antidepressants and other symptom-based therapies can provide some relief, specific treatments for CFS do not exist, the search for them frustrated by the unknown etiology of the illness.
Contact: Laurie K. Doepel
NIH/National Institute of Allergy and Infectious Diseases