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Endocrine system Understanding more about the body’s hormone producing organs, otherwise known as the endocrine system, and how the brain orchestrates this system helps to see its connection to CFS.

Prime organs of the endocrine system are the two adrenal glands, one sitting above each kidney. Among the hormones produced by the outer portion of the adrenal glands is cortisol, essential in controlling proper levels of glucose by stimulating liver synthesis of this blood sugar. Cortisol also ensures that glucose is readily available for proper brain functioning by restricting glucose uptake by body tissues. Another benefit of this hormone is that it breaks down fat for use as energy.

Cortisol’s ability to manage blood sugar levels is important in mobilizing energy to deal with physical or emotional stress. While the adrenal glands have a normal cycle of cortisol production, this cycle is interrupted when a particular stressor comes along and cortisol production is increased to provide the necessary response.

This adrenal gland stimulated response to stress works in tandem with the nervous system’s fight-flight response. Hormones, including adrenaline, produced from the inner portion of the adrenals govern the fight-flight reaction. These hormones regulate carbohydrate metabolism when we are excited or stressed. They also increase heartbeat and respiration, preparing the body for either flight to escape from the danger or to fight in defense.

Hormone Imbalance in CFS The adrenal gland secretions of hormones are controlled through a delicate balance with other hormones produced by the hypothalamus and pituitary glands located in the lower part of the brain.

What researchers are finding is that there appears to be reduced production of hormones of these controlling glands as well as reduced cortisol production in CFS patients. There also appears to be an improper response of these hormones to each other.

Mark Demitrack, M.D. s a leading U.S. researcher on improper hormone function in CFS patients. In his studies of persons with CFS, he has found significant reduction in both blood and urine levels of important adrenal hormones including cortisol.

Demitrack’s investigations, however, have led him to believe the fault is not so much in the adrenal glands as with the nervous system’s interplay and control of these glands. Because malfunctions in this regard negatively impact the body’s ability to cope with stress and because CFS patients’ symptoms often worsen in reaction to physical and emotional response, he feels CFS should be viewed as a stress-related disorder.

Two Irish doctors, Lucinda Scott, MB, MRCPsych and Timothy Dinan, MD, PhD, have also extensively researched neuroendocrine dysfunction, the medical description for abnormal interactions between the nervous system and the hormones of the endocrine system. The doctors’ studies have confirmed much of Demitrack’s findings.

What is more, in the first study of its kind, these doctors discovered the actual size of the adrenal glands in a small group of CFS patients was half that of normal persons. However, like Demitrack, they feel the origin of this problem may not be with adrenals themselves.

Interestingly, immune system problems often seen in CFS correlate with neuroendocrine imbalance since adrenal hormones including cortisol regulate various aspects of immune activity. Under-functioning of the adrenal glands, called hypoadrenalism, could “encourage a state of chronic immunological activation” according to Anthony Komaroff M.D. of Harvard’s School of Medicine. Thus a Dutch study published earlier this year found that ‘the interaction between neuroendocrine system and the immune system is disturbed in CFS.’

Treatment Jacob Teitelbaum, M.D., in his book From Fatigued to Fantastic, discusses the significance of hormone imbalance in CFS patients. He states that “if the cortisol level is low, the person has fatigue, low blood pressure, hypoglycemia, poor immune function, an increased tendency to allergies and environmental sensitivity, and an inability to deal with stress.” Thankfully for some CFS sufferers who have such symptoms and who have medically confirmed adrenal hormone insufficiency, medical management is possible.

Dr. Teitelbaum explains that in his experience and that of an endocrinologist, persons “with either low hormone production or a low reserve often respond dramatically to treatment with a low dose of adrenal hormone.” Although he acknowledges that some use adrenal glandulars from health food stores, he is concerned that variance in the quality and strength of such supplements could lead to overdosing and toxicity.

Thus he prefers using a prescription hydrocortisone (therapeutic cortisol) such as Cortef. And while many are concerned about use of steroids such as hydrocortisone, Dr. Teitelbaum reassures that the key to avoiding side affects is to avoid the higher dosages, in the range of 25 mg. to 35 mg., used in some trials.

Confirming Dr. Teitelbaum’s conclusions is a British study published in the Lancet in 1999, where doctors from England report using 5-10 mg. daily for one month in persons with CFS. The results were that “about a third of the patients had a clinically significant reduction in fatigue, most to a level at or below that of the general population, with accompanying reductions in disability.” Riccardo Baschetti, M.D., in Italy has also published his favorable results from the use of hydrocortisone in low dosages (10-15mg.) in CFS patients.

Another often recommended treatment for hormone imbalance is carefully graded exercise. (Exercise started at very modest levels and gradually increased in duration and rigor, is necessary to limit the negative consequences of overexertion in CFS patients.) This is because exercise is one of the most potent activators of the adrenal function. Such activity can actually increase cortisol output and alleviate a degree of symptoms.

Much research is currently ongoing in the field of hormone imbalance in CFS patients. However, enough research and evidence has been accumulated to cause many doctors to feel it is now appropriate to treat certain CFS patients with hormone replacement therapy. For some with CFS, this therapy is already bringing greatly needed relief.