Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Chronic fatigue

Riccardo Baschetti
CMAJ August 15, 2006 175 (4) 386-386-a; DOI: https://doi.org/10.1503/cmaj.1060098
Riccardo Baschetti
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Jacques Cornuz and colleagues,1 in Box 2 of their case report, list 11 initial laboratory tests for patients with prolonged or chronic fatigue. Given that hypocortisolism is one of the most frequently reported abnormalities of patients with chronic fatigue syndrome,2–5 it is surprising that none of the available tests for assessing cortisol production2–5 was included. The importance of this assessment is especially evident in light of the virtually complete recovery of patients with chronic fatigue who are treated with low-dose hydrocortisone.6

Another rationale for assessing cortisol production in patients with chronic fatigue is the fact that this condition shares 43 clinical features with Addison's disease,7,8 including hypocortisolism, chronic fatigue, and all of the symptoms listed in the diagnostic criteria for chronic fatigue.7 This impressive clinical overlap between 2 distinctly named diseases suggests that in practical terms, chronic fatigue should be regarded as a mild form of Addison's disease.7

Although Cornuz and colleagues, in Table 1 of their paper, correctly mention Addison's disease as one of the major underlying causes of fatigue, they should have remarked that “pigmentation in skin creases, scars and buccal mucosa”1 is far from being a constant feature of Addison's disease.9,10 Therefore, the absence of such pigmentation in patients with chronic fatigue should not mislead general practitioners to exclude hypocortisolism as a possible cause of that unremitting symptom.

REFERENCES

  1. 1.↵
    Cornuz J, Guessous I, Favrat B. Fatigue: a practical approach to diagnosis in primary care. CMAJ 2006;174(6):765-7.
    OpenUrlFREE Full Text
  2. 2.↵
    Jerjes WK, Peters TJ, Taylor NF, et al. Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome. J Psychosom Res 2006;60:145-53.
    OpenUrlCrossRefPubMed
  3. 3.
    Roberts AD, Wessely S, Chalder T, et al. Salivary cortisol response to awakening in chronic fatigue syndrome. Br J Psychiatry 2004;184:136-41.
    OpenUrlAbstract/FREE Full Text
  4. 4.
    Cleare AJ, Blair D, Chambers S, et al. Urinary free cortisol in chronic fatigue syndrome. Am J Psychiatry 2001;158:641-3.
    OpenUrlCrossRefPubMed
  5. 5.
    Scott LV, Medbak S, Dinan TG. Blunted adrenocorticotropin and cortisol responses to corticotropin-releasing hormone stimulation in chronic fatigue syndrome. Acta Psychiatr Scand 1998;97:450-7.
    OpenUrlPubMed
  6. 6.↵
    Cleare AJ, Heap E, Malhi GS, et al. Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet 1999;353:455-8.
    OpenUrlCrossRefPubMed
  7. 7.↵
    Baschetti R. Chronic fatigue syndrome: an endocrine disease off limits for endocrinologists? Eur J Clin Invest 2003;33:1029-31.
    OpenUrlCrossRefPubMed
  8. 8.↵
    Baschetti R. Chronic fatigue syndrome, pregnancy, and Addison disease [letter]. Arch Intern Med 2004;164:2065.
    OpenUrlPubMed
  9. 9.↵
    Kendereski A, Micic D, Sumarac M, et al. White Addison's disease: What is the possible cause? J Endocrinol Invest 1999;22:395-400.
    OpenUrlPubMed
  10. 10.↵
    Soule S. Addison's disease in Africa — a teaching hospital experience. Clin Endocrinol 1999;50:115-20.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 175 (4)
CMAJ
Vol. 175, Issue 4
15 Aug 2006
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Chronic fatigue
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Chronic fatigue
Riccardo Baschetti
CMAJ Aug 2006, 175 (4) 386-386-a; DOI: 10.1503/cmaj.1060098

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Chronic fatigue
Riccardo Baschetti
CMAJ Aug 2006, 175 (4) 386-386-a; DOI: 10.1503/cmaj.1060098
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • REFERENCES
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hospital-at-home programs in Canada: challenges and pitfalls
  • Author response to “Pitfalls of analyzing perinatal outcomes by health care provider”
  • Pitfalls of analyzing perinatal outcomes by health care provider
Show more Letters

Similar Articles

Collections

  • Topics
    • Family medicine, general practice, primary care

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire