Low-Dose Hydrocortisone May Also Ease CFIDS Symptoms

From the WebMD Archives

Nov. 16, 1999 (Atlanta) -- People with chronic fatigue and immune disease syndrome (CFIDS) have abnormally low corticosteroid levels. However, giving cortisone (cortisol, called hydrocortisone in medications) to correct CFIDS typically reduces adrenal function -- a side effect that can eventually cause other health problems such as high blood pressure, diabetes, and cataracts. Now, a study by British researchers shows that giving low doses of hydrocortisone to people with CFIDS may lessen the risk of side effects and serious adrenal-gland problems. The study was published in a recent issue of The Lancet.

"This is a great article, because it tells us two things," Charles Lapp, MD, tells WebMD. "One is, if you do correct the defect [low cortisol levels], some people improve ... and number two, [the researchers] have given us a rough idea at what level of cortisone we can treat and not cause adrenal suppression." Lapp, who was not involved in the study, is the director of the Hunter Hopkins Center in Charlotte, N.C., which specializes in CFIDS, fibromyalgia, and related conditions.

The researchers -- led by Anthony Cleare, MRCpsych at the Guy's King's and St Thomas' School of Medicine in London -- followed 32 CFIDS patients being treated in British clinics that specialize in CFIDS. One group of patients received low (5 mg) doses of hydrocortisone, and another received a higher dose (10 mg). A third group was given a placebo (a similar-appearing but inactive substance ) and served as a comparison ("control") group.

Patients who received the low dose of hydrocortisone experienced as much fatigue relief as those on the higher dose, and both groups experienced significant symptom relief compared with those who did not receive hydrocortisone (placebo group).

"I am delighted to see this [study], because many of us have found that the low doses are helpful for many of our patients. This will [provide] some validation for the use of low-dose [hydro]cortisone in those patients that seem to benefit," says Lapp, who adds that the study also helps quantify the amount of hydrocortisone that is safe.

But he is cautious: "I would not use it in [just] anybody. The problem is [that] ? cortisol can cause cataracts, high blood pressure, diabetes, soft bones, and all kinds of adverse effects. So I would not jump lightly into this." Lapp and the researchers call for larger clinical trials to confirm the findings and investigate long-term outcomes.

"When you don't know the cause, and you don't know the cure, what you have to do is treat the patient supportively -- good diet, vitamins, exercise -- and symptomatically. So this [offers] another treatment we can use," Lapp says.