# CFS, Pregnancy, & Addison Disease



## M&M (Jan 20, 2002)

Posted to the Co-Cure mailing list...


> quote:Chronic Fatigue Syndrome, Pregnancy, and Addison DiseaseJournal: Arch Intern Med. 2004;164:2065.Author: Riccardo Baschetti, MDSchacterle and Komaroff1 found that the rate of spontaneous abortions wasnearly 4 times higher (30% vs 8%) in the pregnancies that occurred afterthe onset of chronic fatigue syndrome (CFS) compared with those thatoccurred before its onset. In light of the results of a Danish survey2that reported an increased risk of spontaneous abortion with increasingmaternal age, Schacterle and Komaroff1 argue that their findings could beexplained by the fact that the mean ï¿½ SD age of those who became pregnantbefore the onset of CFS was 24.8 ï¿½ 4.3 years, whereas it was 33.0 ï¿½ 4.5years for those who became pregnant after that onset. However, if wecompare these ranges of maternal ages with similar ranges (25-29 yearsand 35-39 years) found in the Danish study,2 it is clear that the nearly4-fold higher rate mentioned above is significantly greater than theapproximate 2-fold higher rate (24.6% vs 11.9%) of spontaneous abortionsreported in older Danish women.2Considering that CFS shares 42 clinical features with Addison disease,3including all the diagnostic criteria for CFS, hypocortisolism, reducedadrenal gland size, and other adrenal abnormalities,3 it is reasonable tosuggest that the higher rate of spontaneous abortions that occurred afterthe onset of CFS1 is partly due to the well-recognized mildhypocortisolism that characterizes CFS.3-4 The rate of spontaneousabortions is also abnormally high in women with Addison disease5;therefore, it may well be regarded as the 43rd feature that CFS shareswith Addison disease.3Schacterle and Komaroff1 also found that developmental delays or learningdisabilities were reported more often in the offspring of women whobecame pregnant after (vs before) the onset of CFS. These adverseoutcomes in offspring of women with CFS may represent an additionalconsequence of their hypocortisolism because "maternal cortisol secretionis of great importance to maintain fetal growth, development andwell-being."5In healthy pregnant women, cortisol levels rise progressively and soremarkably as to triple by midgestation.5 In contrast, pregnant womenwith Addison disease are unable to increase their cortisol secretion.5Their serum cortisol level can be normal but inappropriately low for thegestational period and, consequently, they need hydrocortisone more thanever.5 Likewise, in view of the 43 features that CFS shares with Addisondisease,1, 3, 5 especially pregnant women with CFS and their fetusescould benefit from low doses of hydrocortisone, which proved safe andsubstantially beneficial for general patients with CFS.4__________________________Dr Baschetti is a retired medical inspector of the Italian StateRailways.AUTHOR INFORMATIONRiccardo Baschetti, MDCorrespondence: Dr Baschetti, CP 671, 60001-970 Fortaleza (CE), Brazil(baschetti###baydenet.com.br).REFERENCES1. Schacterle RS, Komaroff AL. A comparison of pregnancies that occurbefore and after the onset of chronic fatigue syndrome. Arch Intern Med.2004;164:401-404. ABSTRACT/FULL TEXT2. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M.Maternal age and fetal loss: population based register linkage study.BMJ. 2000;320:1708-1712. ABSTRACT/FULL TEXT3. Baschetti R. Chronic fatigue syndrome: an endocrine disease off limitsfor endocrinologists? Eur J Clin Invest. 2003;33:1029-1031. CrossRef |ISI | MEDLINE4. Cleare AJ, Heap E, Malhi GS, Wessely S, O'Keane V, Miell J. Low-dosehydrocortisone in chronic fatigue syndrome: a randomised crossover trial.Lancet. 1999;353:455-458. CrossRef | ISI | MEDLINE5. Ambrosi B, Barbetta L, Morricone L. Diagnosis and management ofAddison's disease during pregnancy. J Endocrinol Invest. 2003;26:698-702.MEDLINE


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