Endocrine Abstracts

We report three patients who were referred for possible chronic fatigue syndrome and presented with a long standing history of a multitude of symptoms. Comprehensive investigations revealed a low IGF1 and subsequent insulin tolerance test (ITT) demonstrated growth-hormone (GH) deficiency with a normal MRI pituitary in each case. The first patient presented at the age of 34 years with lethargy, aches and difficulty concentrating. Biochemically the only abnormality in th]e basal pituitary tests was a low IGF1 of 9.7 nmol/l (15–39.9). She underwent an ITT where the peak GH-level was low at 0.2 μg/l and the peak cortisol was suboptimal at 414 nmol/l. Her AGHDA score was 20/25 and her symptoms responded dramatically to GH replacement. Her MRI pituitary was normal and currently she takes hydrocortisone at times of stress.

The second patient presented at the age of 36 years with a multitude of symptoms, including lethargy and generalised aches. Biochemistry revealed a low IGF-1 of 12 nmol/l (15–39.9), but no other hormonal deficiencies. He underwent an ITT where all the GH-levels were <0.1 μ/l and the peak cortisol was normal at 597 nmol/l. Her AGHDA score was 25/25 and the MRI pituitary was normal. GH replacement was commenced with an improvement in all the symptoms.

The third patient presented at the age of 33 years with difficulty losing weight and tiredness. He had a low IGF-1 at 9.5 nmol/l (15–39.9). After an ITT all the GH-levels were <0.1 μg/l and the peak cortisol was suboptimal at 323 nmol/l. Currently after 2 years on GH replacement he has managed to lose weight and is ‘much happier with life’.

Patients with multitude of symptoms and/or chronic fatigue syndrome should have endocrinological investigations, in particular looking for GH deficiency, despite normal MRI pituitary. We recommend that all patients with these symptoms should be referred to an endocrinologist for further assessment.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.