Adrenal fatigue in ME

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CharlotteV
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by CharlotteV on Wed Aug 14, 2013 11:41 am

Adrenal fatigue in ME

Although I've repeatedly been diagnosed over the years with ME (narrowly defined, not just the Oxford criteria), an infectious disease consultant recently suggested that my symptoms might be due to adrenal fatigue. Having read up on it, I recognise some of the symptoms. However, other people with ME report feeling worse if treated with hydrocortisone and other corticosteroids and I'm nervous about being treated (I'm waiting for blood results to come back).

I'm also aware that ME is defined by many as a neuro-endocrine-immune disorder and that adrenal issues might be part of the picture but not the cause. I think Dr De Meirleir advises against (or perhaps just doesn't support) direct treatment of adrenal fatigue in ME, perhaps because steroids suppress the immune system or perhaps have other unintended effects.

I'm wondering what to do for the best if my cortisol tests come back indicating adrenal fatigue. Can you please advise me?

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Dr Charles Shepherd
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by Dr Charles Shepherd on Wed Aug 14, 2013 12:31 pm

Re: Adrenal fatigue in ME

Charlotte

One of the most consistent research abnormalities to be reported in ME/CFS is a disturbance in the hypothalamic-pituitary-adrenal (HPA) axis - a complicated hormonal cascade that controls the output of cortisol from the adrenal glands - that sit above the kidneys. If you want to follow this up the research is summarised in the Research section of the MEA booklet: ME/CFS/PVFS - An Exploration of the Key Clinical Issues, along with relevant references.

This can then result in what we call hypocortisolaemia - a slightly reduced output of cortisol from the adrenal glands. But not the severe decrease that is found in a life-threatening condition called Addison's disease, which has some overlapping clinical features with ME/CFS.

So a test of adrenal function normally forms part of the routine clinical assessment in ME/CFS - and if there is any doubt about a diagnosis of Addison's disease other tests of adrenal function (eg a synacthen test) will be arranged. These investigations are covered in more detail in the MEA booklet referred to already.

As far as treating ME/CFS with low doses of steroids (to raise the level of cortisol) there have been two clinical trials. These are summarised and referenced in the Treatment section of the MEA booklet. The consensus amongst medical opinion at present is that any small benefit is outweighed by the risk of causing further disruption to the HPA. So treatment with low doses of steroids (eg hydrocortisone) is not recommended for ME/CFS.
Dr Charles Shepherd
MB BS, Honorary Medical Adviser, ME Association

CharlotteV
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Joined: Tue Aug 13, 2013 7:49 pm

by CharlotteV on Wed Aug 14, 2013 12:45 pm

Re: Adrenal fatigue in ME

Thank you. I'll print off your reply and take it to the consultant.

Do you have any view on treating adrenal fatigue with supplements, 'adaptogen' herbs and so on?

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Dr Charles Shepherd
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by Dr Charles Shepherd on Wed Aug 14, 2013 1:00 pm

Re: Adrenal fatigue in ME

Charlotte

First of all you need to confirm (through proper investigations) that you have a significant abnormality in adrenal gland function

If so, this should then be discussed with an endocrinologist (hormone expert)

This is not an area for self-treatment and I am not aware of any evidence supporting the use of supplements or herbs to treat adrenal gland dysfunction

So I would not recommend this route
Dr Charles Shepherd
MB BS, Honorary Medical Adviser, ME Association

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