Endocrine Abstracts

Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin, the nature of the pathophysiological components remains unclear. Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis; although the quality of many studies is poor, the overall balance of evidence points to reduced cortisol output in at least some patients, with some evidence that this is linked to symptom production or persistence. However, there is no evidence for a specific or uniform dysfunction of the HPA axis.

A 53yr old lady with a history of of cold and neck swelling for few weeks took a course of antibiotics ,numbness and pain in her legs started 6 years back,these symptoms progressively worsening since last 6months.She has no past medical history of medical illness before 1998, had hysterectomy , her body mass index of 21, no medications or steroids in the past or recent,no weight loss. Smoker, social alcohol use On clinical examination no positive findings. Her urinary cortisol normal X 3,suboptimal response to glucagon and insulin stress test. The basal cortisol was normal but response to hypoglycaemia was subnormal ,ACTH fails to rise in response to hypoglycaemia. CRH test showed normal response.Growth hormone showed good response. MRI pituitary (pre and post contrast) right side of pituitary glands appears a little expanded and there is a suspicious of small pituitary adenoma.Prolactin,TFT,I GF,FSH,LH was high with a low estradiol .Short synacthen test was normal.

CONCLUSION

There is evidence for heightened negative feedback and glucocorticoid receptor function and for impaired ACTH and cortisol responses to a variety of challenges on a background of a pituitary incidentaloma