ECE2015 Eposter Presentations Clinical Cases–Pituitary/Adrenal (95 abstracts)
An underactive hypothalamo-pituitary-adrenal axis in a shift worker with chronic fatigue syndrome
Ljiljana Marina , Svetlana Vujovic , Miomira Ivovic , Milina Tancic-Gajic , Zorana Arizanovic , Dragana Rakovic , Milos Zarkovic , Tijana Lalic , Marina Nikolic-Djurovic , Zvezdana Jemuovic & Dragan Micic
Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Introduction: Chronic fatigue syndrome is characterised by a state of chronic fatigue that persists for more than 6 months and has no clear cause.
Case report: A 38-year-old male was referred to our Clinic due to chronic fatigue, unrefreshing sleep, substantial impairment in concentration, headaches and postexertional malaise lasting from 6 to 9 months for 9 years. As a mechanical engineer he was working in shifts 12 h day/24 h break/12 h night/72 h break for 9 years. Other than allergy to penicillin he denied any significant health issues. Complete blood count, liver and kidney function tests, basal gonadotropin, TSH, prolactin, ACTH, cortisol and testosterone levels were normal. Hepatitis B, C, HIV and anti nuclear antibodies were negative. Chest X-ray and abdominal ultrasound were normal. Psychiatrist excluded a psychiatric disorder. Standard and 1 μg Synacthen test showed inadequate peak cortisol 419 and 532 nmol/l respectively. Insulin tolerance test, with hypoglycaemia of 1.2 mmol/l in 30’, showed inadequate peak responses of ACTH 25 ng/l in 30’, cortisol 345 nmol/l in 60’, prolactin 282 mIU/l and low normal growth hormone 22 mIU/l in 60’. Endocranium with hypothalamo-pituitary region MRI was normal. The patient was diagnosed with chronic fatigue syndrome (CFS). As we advised he stopped working in shifts and commenced a low-grade physical activity with cognitive – behavioural therapy. After 6 months he was complaint free with adequate cortisol levels in standard and 1 μg Synacthen test, 718 and 715 nmol/l respectively. After a year he was still complaint free with basal cortisol 570 nmol/l.
Conclusion: The cause of CFS in our patient was the long-term exposure to a stressor – shift work, which led to a circadian disruption, crashing adaptive mechanisms and leading to a disease.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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