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February 11, 1998

Chronic Fatigue Syndrome—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(6):431-433. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-6-jac81007

In Reply.— Dr Baschetti correctly states that many of the symptoms of Addison disease overlap those of CFS. As I mentioned in the case discussion, formal studies of the hypothalamic-pituitary-adrenal axis in patients with CFS have suggested a central underproduction of corticotropin releasing hormone but have not found evidence of primary adrenal insufficiency.1 Moreover, a randomized controlled trial of low-dose cortisol replacement therapy has been conducted by the National Institutes of Health. The unpublished study, reported at a scientific meeting,2 found no benefit from replacement therapy.

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