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Combined dexamethasone/corticotropin-releasing factor test in chronic fatigue syndrome

Published online by Cambridge University Press:  06 September 2007

F. Van Den Eede ,
G. Moorkens ,
W. Hulstijn ,
B. Van Houdenhove ,
P. Cosyns ,
B. G. C. Sabbe  and
S. J. Claes
F. Van Den Eede
Affiliation:
Department of Psychiatry, Antwerp University Hospital, Edegem, Belgium Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium Department of Molecular Genetics VIB8, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Antwerp, Belgium
G. Moorkens
Affiliation:
Department of Internal Medicine, Antwerp University Hospital, Edegem, Belgium
W. Hulstijn
Affiliation:
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
B. Van Houdenhove
Affiliation:
Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
P. Cosyns
Affiliation:
Department of Psychiatry, Antwerp University Hospital, Edegem, Belgium Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
B. G. C. Sabbe
Affiliation:
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium Psychiatric Hospital St.-Norbertushuis, Duffel, Belgium
S. J. Claes*
Affiliation:
Department of Molecular Genetics VIB8, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Antwerp, Belgium Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
*
*Address for correspondence: Professor S. J. Claes, M.D., Ph.D., Department of Psychiatry, University Hospital Gasthuisberg, Herestraat 49, B-3000Leuven, Belgium. (Email: Stephan.Claes@uz.kuleuven.be)
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Abstract

Background

Studies of hypothalamic–pituitary–adrenal (HPA) axis function in chronic fatigue syndrome (CFS) point to hypofunction, although there are negative reports. Suggested mechanisms include a reduced hypothalamic or supra-hypothalamic stimulus to the HPA axis and enhanced sensitivity to the negative feedback of glucocorticoids. The aim of the current study was to investigate HPA axis function in CFS with the dexamethasone/corticotropin-releasing factor (Dex/CRF) test, in analogy with research in affective disorders.

Method

Thirty-four well-characterized female CFS patients and 25 healthy control subjects participated in the low-dose Dex/CRF test. Current major depressive episode was an exclusion criterion. History of early-life stress (ELS) was assessed with the Structured Trauma Interview.

Results

Salivary cortisol responses after 0.5 mg Dex were lower in CFS patients than in controls (before 100 μg CRF, p=0.038; after 100 μg CRF, p=0.015). A secondary analysis revealed an influence of early-life stress and of oestrogen intake. After removal of the 10 participants who were taking an oral oestrogen, patients without a history of ELS showed lower cortisol responses than patients with ELS and controls (before CRF, p=0.005; after CRF, p=0.008).

Conclusions

CFS is globally associated with reduced cortisol responses in the combined low-dose Dex/CRF test, but this effect is only clearly present in CFS patients without a history of ELS. This study provides further support for an enhanced glucocorticoid negative feedback and/or a reduced central HPA axis drive in CFS. Furthermore, it demonstrates that ELS is an important variable to consider in CFS research.

Keywords

Child abusecortisolCRFsomatoform disorderstress
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 7 , July 2008 , pp. 963 - 973
Copyright
Copyright © 2007 Cambridge University Press

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