The Journal of Chronic Fatigue Syndrome reported a study that was conducted on the hypothalamic dysfunction believed to be a part of CFS and Fibromyalgia. The Journal reports about the controversy surrounding the incidence and signifigance of hypothalamic-pituitaryadrenal (HPA) axis dysfunction in Chronic Fatigue Syndrome and Fibromyalgia. There has been controversy surrounding the theory because ACTH stimulation tests and baseline cortisol testing lack the sensitivity to detect this central dysfunction.
It is believed that both CFS and FM patients have central HPA dysfunction. The difference is that in CFS patients appears to be at the pituitaryhypothalamic level while the dysfunction in FM is more related to dysfunction at the hypothalamic and supra-hypothalamic levels.
Treatment for this among both CFS and FM patients has been to prescribe low doses of Cortisol since it has been proven safe and effective, especially if the patient has symptoms including adrenal dysfunction, have low blood pressure, or have baseline cortisol levels in the low or low-normal range. I am on 15 mg a day of Cortisol and have been taking it regularly for the past 2 1/2 years.