Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome.
Tokumasu. Kazuki K; Ochi. Kanako K; Otsuka. Fumio F
Key Findings
- Combined ACTH and GH deficiency can present as chronic fatigue and fibromyalgia‑like symptoms.
- A growth hormone‑releasing peptide‑2 (GHRP‑2) stimulation test can uncover GH deficiency in such patients.
- Physiologic hormone replacement (hydrocortisone and GH) markedly reduced fatigue, muscle pain, and depression.
Practical Outcomes
- If you experience persistent, unexplained fatigue, consider getting an endocrine workup that includes an ACTH test and a GHRP‑2 stimulation test for GH. Positive results may justify low‑dose hydrocortisone and/or GH therapy, which could dramatically improve energy levels and mood. This approach is a potential diagnostic shortcut before assuming chronic fatigue syndrome.
Summary
A 42‑year‑old man with years of severe fatigue was found to have both ACTH and growth hormone (GH) deficiencies. A simple test using the peptide GHRP‑2 revealed the GH deficiency, and hormone replacement (hydrocortisone for ACTH and GH therapy) improved his fatigue, muscle pain, and mood. The report suggests that hidden hormone shortages can mimic chronic fatigue syndrome.
Abstract
A 42-year-old man who had suffered from severe fatigue for 5 years was diagnosed as having chronic fatigue syndrome (CFS) and fibromyalgia. Endocrinological workup using combined anterior pituitary function tests showed that the patient had adrenocorticotropin hormone (ACTH) deficiency, with a normal pituitary MRI. Treatment with a physiologic dose of oral hydrocortisone replacement physically ameliorated his general fatigue. A secondary workup using a growth hormone-releasing peptide-2 test revealed that he also had growth hormone (GH) deficiency, and GH replacement therapy was started. His muscle pain and depression were improved by the therapy. Here, we present a rare case of combined deficiency of ACTH and GH in a middle-aged man with severe general fatigue. This case report aims to raise awareness of combined deficiency of ACTH and GH as a differential diagnosis of CFS and its mimics.
Study Information
pubmed
2021
2021-10-22T00:00:00.000Z
10.1136/bcr-2021-244861
3
25