Advertisement

Neuroendocrine aspects of chronic fatigue syndrome: a commentary

  • Mark A. Demitrack
    Correspondence
    Requests for reprints should be addressed to Mark A. Demitrack, MD, Lilly Research Laboratories, DC 0532, Lilly Corporate Center, Indianapolis, Indiana 46285
    Affiliations
    Lilly Research Laboratories, Neuroscience Therapeutic Area, Indianapolis, Indiana, USA
    Search for articles by this author
      Chronic fatigue syndrome (CFS) remains a vexing problem for patients and clinicians nearly a decade after its formal reintroduction to the medical world.
      • Holmes G.P.
      • Kaplan J.E.
      • Gantz N.M.
      • et al.
      Chronic fatigue syndrome a working case definition.
      Beginning in the early 1980s, independently assembled case series began to appear in the medical literature
      • Jones J.F.
      • Ray G.
      • Minnich L.L.
      • Hicks M.J.
      • Kibler R.
      • Lucas D.O.
      Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses elevated anti-early antigen antibodies.
      ,
      • Straus S.E.
      • Tosato G.
      • Armstrong G.
      • Lawley T.
      • Preble O.T.
      • Henle W.
      • Davey R.
      • Pearson G.
      • Epstein J.
      • Brus I.
      Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection.
      ,
      • Tobi M.
      • Morag A.
      • Ravid Z.
      • Showers I.
      • Feldman-Weiss V.
      • Michaeli Y.
      • Ben-Chetrit E.
      • Shalit M.
      • Knobler H.
      Prolonged atypical illness associated with serological evidence of persistent Epstein-Barr virus infection.
      describing a syndrome of profound and disabling fatigue accompanied by an array of somatic symptoms. In these reports, particular attention was paid to the apparent postinfectious onset of the syndrome. By the end of that decade there were at least 3 major published clinical case definitions of this perplexing illness.
      • Holmes G.P.
      • Kaplan J.E.
      • Gantz N.M.
      • et al.
      Chronic fatigue syndrome a working case definition.
      ,
      • Lloyd A.R.
      • Wakefield D.
      • Boughton C.
      • Dwyer J.
      Prevalence of chronic fatigue syndrome in an Australian population.
      ,
      • Sharpe M.C.
      • Archard L.C.
      • Banatvala J.E.
      • Borysiewicz L.K.
      • Clare A.W.
      • David A.
      • Edwards R.H.T.
      • Hawton K.E.H.
      • Lambert H.P.
      • Lane R.J.M.
      • McDonald E.M.
      • Mowbray J.F.
      • Pearson D.J.
      • Peto T.E.A.
      • Preedy V.R.
      • Smith A.P.
      • Smith D.G.
      • Taylor D.J.
      • Tyrell D.A.J.
      • Wessely S.
      • White P.
      • Behan P.O.
      • Rose F.C.
      • Peteres T.J.
      • Wallace P.G.
      • Warrell D.A.
      • Wright D.J.M.
      A report—chronic fatigue syndrome guidelines for research.
      The definition originally developed by a Centers for Disease Control and Prevention (CDC) working group has recently been revised by international consensus and serves as the most widely quoted definition.
      • Fukuda K.
      • Straus S.E.
      • Hickie I.
      • Sharpe M.C.
      • Dobbins J.G.
      • Komaroff A.
      The International Chronic Fatigue Syndrome Study Group
      The chronic fatigue syndrome a comprehensive approach to its definition and study.
      Despite initial enthusiasm that these definitions would assist in the rapid identification of a discrete, homogeneous population of patients, all of these clinical descriptions are now thought to encompass a collection of individuals who are heterogeneous in both past history and clinical course. In other words, CFS describes a clinical condition (i.e., a final common outcome) that may develop from varying combinations of antecedent risk factors, rather than representing a single, distinct disease entity. One of the more important observations has been the realization that the postinfectious cohort is only one clinical type of this illness. Indeed, CFS is clearly not an infectious disease. A substantial number of individuals may, in fact, develop CFS in the absence of any triggering infectious event.
      • Salit I.
      Precipitating factors for the chronic fatigue syndrome.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Holmes G.P.
        • Kaplan J.E.
        • Gantz N.M.
        • et al.
        Chronic fatigue syndrome.
        Ann Intern Med. 1988; 108: 387-389
        • Jones J.F.
        • Ray G.
        • Minnich L.L.
        • Hicks M.J.
        • Kibler R.
        • Lucas D.O.
        Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses.
        Ann Intern Med. 1985; 102: 1-7
        • Straus S.E.
        • Tosato G.
        • Armstrong G.
        • Lawley T.
        • Preble O.T.
        • Henle W.
        • Davey R.
        • Pearson G.
        • Epstein J.
        • Brus I.
        Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection.
        Ann Intern Med. 1985; 102: 7-16
        • Tobi M.
        • Morag A.
        • Ravid Z.
        • Showers I.
        • Feldman-Weiss V.
        • Michaeli Y.
        • Ben-Chetrit E.
        • Shalit M.
        • Knobler H.
        Prolonged atypical illness associated with serological evidence of persistent Epstein-Barr virus infection.
        Lancet. 1982; 9: 61-64
        • Lloyd A.R.
        • Wakefield D.
        • Boughton C.
        • Dwyer J.
        Prevalence of chronic fatigue syndrome in an Australian population.
        Med J Aust. 1990; 153: 522-528
        • Sharpe M.C.
        • Archard L.C.
        • Banatvala J.E.
        • Borysiewicz L.K.
        • Clare A.W.
        • David A.
        • Edwards R.H.T.
        • Hawton K.E.H.
        • Lambert H.P.
        • Lane R.J.M.
        • McDonald E.M.
        • Mowbray J.F.
        • Pearson D.J.
        • Peto T.E.A.
        • Preedy V.R.
        • Smith A.P.
        • Smith D.G.
        • Taylor D.J.
        • Tyrell D.A.J.
        • Wessely S.
        • White P.
        • Behan P.O.
        • Rose F.C.
        • Peteres T.J.
        • Wallace P.G.
        • Warrell D.A.
        • Wright D.J.M.
        A report—chronic fatigue syndrome.
        J R Soc Med. 1991; 84: 118-121
        • Fukuda K.
        • Straus S.E.
        • Hickie I.
        • Sharpe M.C.
        • Dobbins J.G.
        • Komaroff A.
        • The International Chronic Fatigue Syndrome Study Group
        The chronic fatigue syndrome.
        Ann Intern Med. 1994; 121: 953-959
        • Salit I.
        Precipitating factors for the chronic fatigue syndrome.
        J Psychiatr Res. 1997; 31: 59-65
        • Wessely S.
        The epidemiology of chronic fatigue syndrome.
        Epidemiol Rev. 1995; 17: 139-151
        • Demitrack M.A.
        Neuroendocrine correlates of chronic fa-tigue syndrome.
        J Psychiatr Res. 1997; 31: 69-82
        • Imboden J.B.
        • Canter A.
        • Cluff L.E.
        Convalescence from influenza.
        Arch Intern Med. 1961; 108: 115-121
        • Ware N.C.
        Suffering and the social construction of illness.
        Med Anthropol Q. 1992; 6: 347-361
        • Demitrack M.A.
        • Dale J.K.
        • Straus S.E.
        • Laue L.
        • Listwak S.J.
        • Kruesi M.J.P.
        • Chrousos G.P.
        • Gold P.W.
        Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome.
        J Clin Endocrinol Metab. 1991; 73: 1224-1234
        • Demitrack M.A.
        The psychobiology of chronic fatigue.
        in: Demitrack M.A. Abbey S.E. Chronic Fatigue Syndrome An Integrative Approach to Evaluation and Treatment. Guilford Press, New York1996
        • Rowe P.C.
        • Calkins H.
        Neurally mediated hypotension and chronic fatigue syndrome.
        Am J Med. 1998; 105: 15S-21S
        • De Becker P.
        • et al.
        Autonomic testing in chronic fatigue syndrome patients.
        Am J Med. 1998; 105: 22S-26S
        • Bou-Holaigah I.
        • Rowe P.C.
        • Kan J.
        • Calkins H.
        Relationship between neurally mediated hypotension and the chronic fatigue syndrome.
        JAMA. 1995; 274: 961-967