Morphologial and functional abnormalities of the hypofyse in patients with diagnose of CFS or fibromyalgia


Dr.  F. Coucke, H. Lammems, L. Coucke en A.B. Vögter bestudeerden het aantal patiënten met endocriene stoornissen (vooral hypofyseafwijkingen) in de "ME/cvs-populatie". Zij komen tot de conclusie dat men bij patiënten met de diagnose ME/cvs bijkomend onderzoek nodig is naar onderliggende chronische aandoeningen. Niet enkel immunologische problemen komen vaak voor, maar ook afwijkingen op endocrien vlak  (oa. bijnierinsufficiëntie, lage IGF-1(insule-like growth factor) en GHD (groeihormoondeficiëntie). Hieruit blijkt dat er in de Belgische referentiecentra veel verkeerde diagnoses gesteld worden.


Morphologial and functional abnormalities of the hypofyse in patients with
diagnose of CFS or fibromyalgia. An example of misdiagnosis by Belgian
chronic fatigue centres

(from: 15th European Congress of Endocrinology, Copenhagen, Denmark.
27 April 2013 - 01 May 2013. European Society of Endocrinology)

http://www.endocrine-abstracts.org/ea/0032/ea0032p222.htm

Endocrine Abstracts (2013) 32 P222
DOI:10.1530/endoabs.32.P222

Morphologial and functional abnormalities of the hypofyse in patients with
diagnose of CFS or fibromyalgia. An example of misdiagnosis by Belgian
chronic fatigue centres

Francis Coucke, Heidi Lammens, Laurens Coucke & Anne-Birgitte Vogter

Aim: In consultation, we check a lot of patients who present with diagnose
of FM (fibromyalgia) and chronic fatigue syndrome (CFS). Most of these
patients have a underlying diagnosis that causes chronic pain or fatigue.
These causes are pathologies not easily detected.

Endocrine failure is one of the candidates, with hypofyse dysfunction as a
possible candidate.

Methods: During 1 year: from October 11, 487 patients presented at the
consultation we found 47 cases of morphological and functional hypofyse
abnormalities. By examining with stress test in patients with clinical
complaints and low basal hormones: e.g. low IGF1 or cortisol, combined with
morphological abnormalities of the hypofyse.

Results: Forty seven patients with abnormalities of the hypofyse:

. Cystes: 6 cases average age 50.8, all female, mean diameter 5.2 mm (from 4
to 8 mm). All are ACTH-cortisol deficient and 1 of them is GH deficient
(GHD).

. Adenomas: 31 cases average age: 42 years, 23 female, 8 males, mean size of
5 mm (from 12 to 3 mm), all are ACTH-cortisol deficient and 11 are also GHD.

. Empty cells: 12 cases: average age: 53, 25 years, 5 males, 7 females, all
deficient in ACTH-cortisol and 8 are GHD.

Conclusion: Patients with a diagnose of CFS or fibromyalgia should always be
checked for underlying chronic diseases. Mostly immunologic but also
endocrine diseases can be underlying. E.g. frequently adrenal insufficiency
can be detected. A lot of reports document also a low
IGF1 and GHD.

Patients with hormone deficiencie should also be checked for other hormone
deficiencies. In case of low hypofyse hormones, single or multiple, the
hypofyse has to be functionally and morphologically checked. On contrary
with the disappointing general therapy of FM or CFS, a good and efficient
therapy can be offered to patients by treating the underlying hormonal
deficiencies.



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