Low-Dose Hydrocortisone for Treatment of Chronic Fatigue Syndrome - A Randomized Controlled Trial, 1998, McKenzie et al

Correction: I just realized I mixed up my cortisol result with my ACTH result. My cortisol level is great, it is actually right in the middle of perfect. So at least in my EBV triggered case, we can rule out any cortisol involvement. It is not even a little bit low.

 

Hydrocortisone dosage in this trial was 13 mg/m^2 body surface area (BSA) in the morning and 3 mg/m^2 in the afternoon.

According to the Du Bois formula, the BSA of a 70kg (154lb), 1.80m (5’11”) tall person is 1.89 m^2.

This would equate to doses of about 25mg in the morning and 6mg in the afternoon. I’m not sure the total dose of 31mg/day can be considered a low one, as the adrenal suppression observed in some participants indicates.

In contrast, Cleare 1998 used 5 or 10mg/day and these dosages did not result in adrenal suppression. Not unlike this trial’s finding of an improvement in “wellness”, they found a mean improvement in fatigue of 4.5 points (95% CI 1.2 to 7.7, p = 0.009) on the Chalder fatigue scale (0-33, Likert scoring), which is barely above the minimal clinically important difference of 3 to 4 points. Similarly to this trial too, no relevant improvements were observed on the Work and Social Adjustment Scale (WSAS) nor on the SF-36 questionnaire.

 

I just checked the paper and the et al includes Stephen Strauss, inventor of CFS, who despised the patients and went to great lengths to spread the word that there was no legitimate disease present.

I seem to remember that Wessely did a cortisol study as well. At the time I felt they were designed to show that the experts were looking into the biological side but were finding there was very little physically wrong with us. I think if th eresults had been positive it would have been hailed as proof we were just anxious or depressed.

 

Hydocortisone is outside patents so drug companies won't fund research....
...and therefore no one has been interested since late 1990s.

 

There’s some money in novel ways of packaging hydrocortisone for slow release or consistent release to mimic natural cortisol production. I’ve recently developed adrenal insufficiency and the Addison’s community, when not talking about olives and salty lemonade, mainly discuss how to get dosage right and the pills that make this easier. There are far more PwME than Addisonians, and the non-generic HC product managers should be eager to find Goldilocks levels for other patient groups.

That said, my experience is that HC exacerbates ME symptoms and adds extra ones on top, so I am sceptical about this remedy, although generally interested in endocrine lines of enquiry.