Adrenal Insufficiency and Chronic Fatigue Syndrome: Any Connection?

After reading Dr Hani Raoul Khouzam’s article “Chronic Fatigue Syndrome: An Update on Diagnosis in Primary Care” (CONSULTANT, February 2011, page 73), I realized that the symptoms of chronic fatigue syndrome (CFS) are extremely similar to those of adrenal insufficiency. At least 8 of the CFS symptoms are identical to the severe withdrawal symptoms a patient experiences from stopping prednisone too quickly. Has adrenal insufficiency been investigated as a cause of CFS?

—— Christine Jones, GYN NP


Thank you for your question. Clinically, chronic fatigue is common in both adrenal insufficiency and CFS. However, adrenal insufficiency is a well-defined medical condition with signs and symptoms in addition to chronic fatigue. These symptoms are not usually present in patients with CFS.

Among the symptoms of acute adrenal insufficiency are dehydration, hypotension, hypoglycemia and, at times, delirium with altered mental status. Acute adrenal insufficiency is usually a complication of an acute medical illness, such as sepsis associated with tuberculosis or chronic fungal infection or disseminated intravascular coagulation. Acute adrenal insufficiency can also occur during labor or following a traumatic delivery.

Patients with chronic adrenal insufficiency may present with increased skin pigmentation, particularly in the areolae and genitalia, as well as in any scars or moles. Pigmentary lines may also be noted on the gums (Figure). Clinically, adrenal insufficiency may result from metastases, especially from breast, lung, stomach, and colon cancer or lymphoma; sarcoidosis; and hemochromatosis. Medications such as ketoconazole, rifampin, phenytoin, barbiturates, megestrol acetate, aminoglutethimide, etomidate, metyrapone, suramin, and mitotane can also cause adrenal insufficiency. Critical illness–related corticosteroid insufficiency is a term that describes sudden withdrawal of long-term corticosteroid therapy and stress in patients with underlying chronic adrenal insufficiency.

So, in summary, in response to your thoughtful comments, adrenal insufficiency is considered one of the conditions in the differential diagnosis of CFS rather than a cause of CFS.

—— Hani Raoul Khouzam, MD, MPH