Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycemia in chronic fatigue syndrome

Bearn, Jenny; Allain, Theresa J.; Coskeran, Patsy; Munro, N.; Butler, Jane; McGregor, A M; Wessely, Simon

doi:10.1016/0006-3223(94)00121-i

Cited by 91 publications

(32 citation statements)

References 26 publications

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“…The recognition of the role of CRH in behavioural activation has led to the hypothesis that defective central CRH release may give rise to behavioural depression and thus fatigue (reviewed in [33]). Studies in chronic fatigue syndrome consistently suggest an impairment of central CRH synthesis and release at the level of the hypothalamus in these patients [33,34]. Although similar studies have been performed for only a few chronic disease states, these also appear to suggest the presence of abnormal central CRH pathways.…”

Section: Corticotropin-releasing Hormone (Crh) and Chronic Stressmentioning

confidence: 87%

Fatigue in chronic disease

2000

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Fatigue is an extremely common complaint among patients with chronic disease. However, because of the subjective nature of fatigue, and the lack of effective therapeutics with which to treat fatigue, this symptom is often ignored by clinicians, who instead focus on hard, objective disease end-points. Recently, the symptom of fatigue has received greater attention as part of overall health-related quality of life assessments in patients with chronic disease. Furthermore, new methods are being developed to help quantify fatigue, and are being utilized more frequently in the clinical setting. Moreover, studies in patients and using animal models of disease have provided some insight into changes within the brain which appear to be linked to the genesis of central fatigue. This review focuses on fatigue in chronic disease and outlines possible mechanisms which may give rise to central fatigue in chronic disease. Moreover, methods for measuring fatigue and an approach to the fatigued patient are discussed. Hopefully, a broader understanding of this distressing symptom will lead to the development of specific therapies for treating fatigue in these patients.

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Section: Corticotropin-releasing Hormone (Crh) and Chronic Stressmentioning

confidence: 87%

Fatigue in chronic disease

2000

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“…This contrasts with Demitrack et al [2], who considered that their results were more in keeping with a central CRH deficiency on the basis of an enhanced response to ACTH and an attenuated response to ovine CRH. We did not perform hormonal stimulation tests, but others have also produced evidence for both pituitary and adrenocortical impairments in CFS [17].…”

Section: Discussionmentioning

confidence: 99%

Diurnal Variation of Adrenocortical Activity in Chronic Fatigue Syndrome

et al. 1998

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Baseline morning and evening serum cortisol and ACTH concentrations, and diurnal changes in hormone levels, were measured in 30 patients with chronic fatigue syndrome (CFS) but without concurrent depressive disorder and a control group of 15 weight-, age- and sex-matched healthy volunteers. Morning cortisol levels were non-significantly lower in CFS patients, while evening levels were non-significantly higher. ACTH concentrations were non-significantly higher in both the morning and evening. The diurnal change in cortisol levels was significantly less in CFS than in controls (p < 0.05). In CFS subjects, evening levels of cortisol correlated significantly with measures of general health and physical functioning, while diurnal change in cortisol was positively correlated with measures of functional improvement over the past year and current social functioning. These results suggest that there is a relationship between adrenocortical function and disability in CFS, but do not reveal the causal connection.

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“…To the best of our knowledge, only 1 study demonstrated reduced ACTH responses in the ITT in CFS [23] . In 2 relatively large studies [24,25] and 1 small study [26] , there were no significant differences in ACTH responses in the ITT between CFS patients and healthy control individuals. These data do not provide strong evidence for a disturbed HPA axis regulation in CFS, although the ITT may be too blunt to be useful in detecting more subtle changes [2] .…”

Section: Challenge Testsmentioning

confidence: 99%

Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome

Eede

Moorkens

Houdenhove³

et al. 2007

Neuropsychobiology

110

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There is evidence for a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis in a proportion of the patients with chronic fatigue syndrome (CFS), despite the negative studies and methodological difficulties. In this review, we focus on challenge studies and on the role of the HPA axis in the pathogenesis of CFS. Mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids are the main findings. Several underlying mechanisms have been proposed. Currently, it is a matter of debate whether these disturbances have a primary role in the pathogenesis of CFS. However, even if the HPA axis dysfunctions are secondary to other factors, they are probably a relevant factor in symptom propagation in CFS.

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Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycemia in chronic fatigue syndrome

Cited by 91 publications

References 26 publications

Fatigue in chronic disease

Fatigue in chronic disease

Diurnal Variation of Adrenocortical Activity in Chronic Fatigue Syndrome

Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome

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