People suffering from chronic fatigue syndrome (CFS) and fibromyalgia may feel better by boosting levels of the stress hormone cortisol with low doses of hydrocortisone. According to Dr. Kent Holtorf, the simple treatment carries significantly less risk and greater potential for benefit than widely accepted treatments for the two conditions. However, some CFS and fibromyalgia experts were not so convinced.

Chronic fatigue syndrome is a debilitating disorder of uncertain cause which occurs mostly in women than in men, and in adults between 40 to 50 years old.

Fibromyalgia is a disorder characterized by the presence of chronic widespread pain and debilitating fatigue.

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. 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.

Dr. William C. Reeves, 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.

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, such as 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.

Fibromyalgia researcher Dr. Lesley Arnold agrees. "The evidence in favor of using steroids to treat these conditions just isn't there," said the University of Cincinnati associate professor of psychiatry. "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."