The role of hypocortisolism in chronic fatigue syndrome, 2014, Nijhof et al

[Hutan]

The role of hypocortisolism in chronic fatigue syndrome

Spoiler: Authors

Nijhof, Sanne L.; Rutten, Juliette M.T.M.; Uiterwaal, Cuno S.P.M.; Bleijenberg, Gijs; Kimpen, Jan L.L.; Putte, Elise M. van de

Abstract
Abstract

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.

Web | DOI | Psychoneuroendocrinology

 

[Hutan]

An older paper that has just been cited in a paper as proving that good treatment not only fixes CFS, but also associated hypocortisolism.

I thought it was worth a look at. I think it's highly likely that the supposedly lower salivary cortisol awakening response is to do with the sleep time shift and lower activity levels that come with CFS. So, a relatively small difference (not abnormal levels) due to the CFS, not a cause of CFS.

 

[Hutan]

It's part of the FITNET trial. Fukuda criteria
118 young people.

There's a paywall, only snippets are freely available.

We identified a mild hypofunction of the HPA-axis at CFS diagnosis compared to healthy peers, manifesting itself in a significantly impaired salivary cortisol awakening response

As expected, It doesn't sound as if there was a big effect.

After treatment recovered patients had a significant rise in salivary cortisol output attaining normalization, whereas non-recovered patients improved slightly, but not significantly.

For goodness sake, these people really saw what they wanted to see. It's far more likely that recovered young people returned to school or work and had to wake up up earlier, and returned to higher levels of activity, both of which are likely to slightly increase the cortisol morning awakening response as measured at 8 am or whatever.

 

[MSEsperanza]

There's a paywall, only snippets are freely available.

As it's an Elsevier journal, just a reminder of their scheme for patient access:

Elsevier journals -- Access for healthcare and patients

Patient access
Patients and caregivers can make requests for individual papers related to medicine and healthcare at no cost. These papers can be requested by e-mailing patientaccess@elsevier.com. We aim to provide the requested articles within 24 hours. Please include the article title and author(s), date published, and/or the URL if available. This will ensure that our team can locate the requested content as quickly as possible. In addition, patients and caregivers who participate in the publication of an article and have a preference or need to publish that article open access, but lack the funds for the Article Publishing Charge, can make a request for a waiver of the APC by emailing oapolicy@elsevier.com . Please include the article title; author(s); and the journal title you have submitted the article to.

https://www.elsevier.com/open-science/science-and-society/access-for-healthcare-and-patients

Repeatedly did this and it always worked.

 

[Jonathan Edwards]

There's a paywall, only snippets are freely available.

If its this one, I had direct access: link

 

[SNT Gatchaman]

That's probably an expiring link with a token using your dept credentials.

This should work.

Sci-Hub

 

[Hutan]

So, the Method has the participants providing salivary cortisol upon waking and then at 15, 30 and 60 minutes after wakening. So, I was thinking that that method could accommodate the different waking times of the healthy controls and the CFS group, knocking out one reason for the peak cortisol to be missed in the CFS group.

However, Table 1 gives the mean awakening time for the two groups. It is 8.43am for both groups. That consistency between the two groups seems remarkably unlikely, especially given what I know about young people with ME/CFS. It suggests to me that there was some guidance given about when the participants should wake up.

Here are the results.



The top charts are unadjusted data, the lower ones are adjusted data. The results were adjusted for gender, age, BMI, depression score, sleep duration and physical activity (actometer) - which seems a bit odd. Why would you adjust salivary cortisol for depression score, for example, and why would that change the shape of the curves?

No indication of variance is given for each data point - we have no idea how much overlap there was between the two comparison data sets at each timepoints.