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February 11, 1998

Chronic Fatigue Syndrome

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

To the Editor.—In his discussion about chronic fatigue syndrome (CFS), Dr Komaroff1 states that, in addition to symptoms included in the case definition, many patients with CFS also frequently report anorexia, nausea, and dizziness. Counting these latter symptoms, which have also been found in adrenal insufficiency,2 CFS shares 23 features with Addison disease,3 including both the symptoms of the case definition for CFS and all the neuropsychological complaints that have led some people to claim that CFS is just a manifestation of an underlying depression. Considering that no medical condition except Addison disease shares more than 20 features with CFS, it is unclear why no study to my knowledge has been performed to determine whether the treatment for Addison disease, ie, hydrocortisone plus fludrocortisone acetate, could also benefit CFS patients. Fludrocortisone is likely to be of benefit based on a previous study in patients with CFS.4