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May 26, 1999

Low-Dose Hydrocortisone for Chronic Fatigue Syndrome

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(20):1887-1889. doi:10.1001/jama.281.20.1887

To the Editor: Dr McKenzie and colleagues1 suggest that hydrocortisone, despite its effectiveness against chronic fatigue syndrome (CFS), should not be used as a prolonged treatment for CFS because they found that "cautious hormonal supplementation" consisting of "low-dose" hydrocortisone caused a significant degree of adrenal suppression. Such suppression, however, may simply indicate that the dosage of hydrocortisone was neither cautiously low nor suitable for CFS patients. Hydrocortisone in dosages greater than 22 mg/d may harm even subjects with bilateral adrenalectomies,2 whose adrenal insufficiency is axiomatically absolute. Therefore, the 25- to 35-mg/d hydrocortisone dosage administered by McKenzie et al clearly represents an inappropriately high dosage for CFS patients, whose adrenal insufficiency is mild, since those authors report that "CFS patients excreted, on average, about 30% less cortisol in 24-hour urine collections than healthy, matched controls."1