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.
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."