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
The problem is that very sophisticated testing is needed to identify this
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
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
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
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.
"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."