Good case review of secondary adrenal insufficiency. A common cause of low sodium and needs to be considered in elderly patients. Also, low cortisol is associated with increased ADH. In the case of adrenal insufficiency, the negative feed back of cortisol to the HPA is lost and recreation of CRH, which is an ADH secretagogue, will increase ADH secretion.
This study reveals CFS to be low adrenal cortisol output problem. In this study, low dose cortisol (hydrocortisone) therapy improved symptoms of fatigue and improved the CRH adrenal stimulation of adrenal cortisol production.
We conclude that the improvement in fatigue seen in some
patients with chronic fatigue syndrome during hydrocortisone treatment
is accompanied by a reversal of the blunted cortisol responses to human
CRH
These data further suggest that the hypocortisolism
found in chronic fatigue syndrome may be secondary to reduced adrenal
gland output.
5-mg replacement dose of
hydrocortisone, and the remainder 10 mg
low dose hydrocortisone therapy (defined as 5-10 mg), in this study, was used to treat CFS. This study found an improvement in symptoms in these patients. Additionally, low cortisol was found in these patients with CFS. Their conclusion, was that low adrenal function is a component of CFS and low dose hydrocortisone therapy is an effective treatment.
Now, is the low cortisol as the result of increased metabolism as well?