# neuroendocrinology of CFS



## trbell (Nov 1, 2000)

The neuroendocrinology of chronic fatigue syndrome.Journal: Endocr Rev 2003 Apr;24(2):236-52Author: Cleare AJ.Affiliation: Section of Neurobiology of Mood Disorders, Division ofPsychological Medicine, The Institute of Psychiatry, London SE5 8AZ,United Kingdom.NLM Citation: PMID: 12700181Chronic fatigue syndrome (CFS) is a common and disabling problem;although most likely of biopsychosocial origin, the nature of thepathophysiological components remains unclear. There has been a wealth ofinterest in the endocrinology of this condition, which will be reviewedin this article.Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis;although the quality of many studies is poor, the overall balance ofevidence points to reduced cortisol output in at least some patients,with some evidence that this is linked to symptom production orpersistence. There is evidence for heightened negative feedback andglucocorticoid receptor function and for impaired ACTH and cortisolresponses to a variety of challenges. However, there is no evidence for aspecific or uniform dysfunction of the HPA axis.Given the many factors that may impinge on the HPA axis in CFS, such asinactivity, sleep disturbance, psychiatric comorbidity, medication, andongoing stress, it seems likely that HPA axis disturbance isheterogeneous and of multifactorial etiology in CFS.Studies assessing GH, dehydroepiandrostenedione and its sulfate,melatonin, leptin, and neuroendocrine-monoamine interactions are alsoreviewed. There is some evidence from these studies to suggestalterations of dehydroepiandrostenedione sulfate function and abnormalserotonin function in CFS, but whether these changes are of functionalimportance remains unclear.To obtain a clearer assessment of the etiological and pathophysiologicalrelevance of endocrine changes in CFS, it is suggested that moreprospective cohort studies be undertaken in groups at high risk for CFS,that patients with CFS are followed up into recovery, and thatmultidimensional assessments are undertaken to unravel the influence ofthe various confounding factors on the observed endocrine changes in CFS.tom


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