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.