Steroid for Chronic Fatigue Syndrome?
Doctor Says He's Had Success With Hydrocortisone for CFS and Fibromyalgia Patients
By
Salynn Boyles
WebMD Health News
Reviewed By
Louise Chang, MD
March 21, 2008 — Boosting levels of the stress hormone cortisol with low doses of
hydrocortisone could help patients with chronic
fatigue syndrome and fibromyalgia feel better, a California doctor says.
Kent Holtorf, MD, says the simple treatment carries significantly less risk
and greater potential for benefit than widely accepted treatments for the two
conditions. But chronic fatigue syndrome (CFS) and fibromyalgia experts who
spoke to WebMD were not so sure.
Holtorf believes the majority of CFS and fibromyalgia patients have low
levels of the steroid hormone cortisol due to dysfunction in a brain system
that regulates response to stress, known as the hypothalamic-pituitary-adrenal
(HPA) axis.
The problem is that very sophisticated testing is needed to identify this
dysfunction.
As a result, while a number of studies have shown lower-than-normal cortisol
levels to be common in CFS and fibromyalgia patients, many others have failed
to show the association.
"The overwhelming majority of these patients have [cortisol]
dysfunction, whether testing shows this or not," he tells WebMD. His review
of the research is published in the latest issue of the Journal of Chronic
Fatigue Syndrome.
Low-Dose Treatment
Holtorf routinely treats patients with chronic fatigue syndrome and
fibromyalgia with low doses (5 to 15 milligrams a day) of the steroid
hydrocortisone, in addition to other treatments, to boost cortisol levels.
Of 500 consecutive patients treated with the steroid at his Torrance,
Calif., clinic, Holtorf says 94% showed some improvement and 62% showed
substantial improvement by the fourth visit.
William C. Reeves, MD, director of the chronic viral diseases branch of the
CDC, believes that most patients with CFS and fibromyalgia could benefit from
taking low-dose hydrocortisone, but he says the treatment is not without
risks.
Reeves and CDC colleagues recently published a study showing that women with
CFS symptoms tend to have lower-than-normal cortisol levels upon waking in the
morning — a time when levels typically spike.
"It does appear that there is something different in HPA axis function
in these patients, but that doesn't necessarily mean that this treatment is the
answer," Reeves says.
Hydrocortisone Benefits and Risks
He cites a 1998 study from the National Institutes of Health examining
low-dose hydrocortisone for the treatment of chronic fatigue syndrome.
Although the treatment was shown to have some benefit, a significant number
of patients also exhibited a common side effect seen with higher steroid doses — adrenal suppression, a reduction in the amount of hormones made by the
adrenal glands.
The researchers concluded that "the degree of adrenal suppression
precludes [the steroid's] practical use for CFS."
"This idea of using low-dose steroids has been around for a long time,
but it may not be as simple as simply raising cortisol levels. And even if it
does help, it is not without risks," Reeves says.
Fibromyalgia researcher Lesley Arnold, MD, agrees.
"The evidence in favor of using steroids to treat these conditions just
isn't there," the University of Cincinnati associate professor of
psychiatry tells WebMD. "We just don't have enough consistent data about
abnormalities in the HPA axis."
Arnold points out that some studies in fibromyalgia patients have shown the
HPA axis activity to be increased and some have shown it to be decreased.
"The only thing that has been consistent is that there is usually some kind
of abnormality in function."
SOURCES: Holtorf, K. Journal of Chronic Fatigue Syndrome, vol 13: pp 1-14. Kent Holtorf, MD, medical director, Holtorf Medical Group Inc., Torrance,
Calif. William C. Reeves, MD, director, chronic viral diseases branch, CDC. Lesley Arnold, MD, associate professor of psychiatry, University of
Cincinnati. McKenzie, R. The Journal of the American Medical Association, Sept.
23, 1998; vol 280: pp 1061-1066.
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