Abstract
Background
Fatigue is a frequently experienced complaint in patients with adrenal insufficiency (AI) and may be influenced by cortisol levels.
Aim
The objective of this study was to determine the prevalence of severe fatigue in adrenal insufficiency (AI) patients, to assess which dimensions contribute to fatigue severity and to determine the association between salivary cortisol levels and momentary fatigue.
Subjects and methods
We performed a cross-sectional study in the outpatient department of a university hospital. Included were 27 patients with congenital adrenal hyperplasia (CAH), 26 patients with primary AI (PAI), 24 patients with secondary AI (SAI) and 31 patients with adrenal insufficiency after treatment for Cushing’s syndrome (Cush-AI). Measurements included computerised questionnaires to determine fatigue severity and physical and psychosocial contributors. Patients took four saliva samples at home, in which cortisol levels were measured.
Results
Severe fatigue was experienced by 41 % of the CAH patients, 42 % of the PAI patients, 50 % of the SAI patients and 42 % of the Cush-AI patients. Psychological distress, functional impairment, sleep disturbance, physical activity, concentration problems and social functioning contributed to the subjective experience of fatigue. Salivary cortisol levels were not correlated with momentary fatigue.
Conclusions
A considerable proportion of AI patients experience severe fatigue. Salivary cortisol level is not a significant predictor for momentary fatigue in AI patients.
Abbreviations
- AI:
-
Adrenal insufficiency
- CAH:
-
Congenital adrenal hyperplasia
- PAI:
-
Primary adrenal insufficiency
- SAI:
-
Secondary adrenal insufficiency
- Cush-AI:
-
AI-after treatment for Cushing’s syndrome
- CFS:
-
Chronic fatigue syndrome
- CIS:
-
Checklist Individual Strength
- AFQ:
-
Abbreviated Fatigue Questionnaire
- BDI:
-
Beck Depression Inventory
- SCL-90:
-
The 90-item Symptom Checklist
- SIP:
-
Sickness Impact Profile
- SF-36:
-
Short Form Health Survey
References
Thomsen AF, Kvist TK, Andersen PK, Kessing LV (2006) The risk of affective disorders in patients with adrenocortical insufficiency. Psychoneuroendocrinology 31:614–622
Lovas K, Loge JH, Husebye ES (2002) Subjective health status in Norwegian patients with Addison’s disease. Clin Endocrinol (Oxf) 56:581–588
Hahner S, Loeffler M, Fassnacht M et al (2007) Impaired subjective health status in 256 patients with adrenal insufficiency on standard therapy based on cross-sectional analysis. J Clin Endocrinol Metab 92:3912–3922
Bleicken B, Hahner S, Loeffler M et al (2010) Influence of hydrocortisone dosage scheme on health-related quality of life in patients with adrenal insufficiency. Clin Endocrinol (Oxf) 72:297–304
Nermoen I, Husebye ES, Svartberg J, Lovas K (2010) Subjective health status in men and women with congenital adrenal hyperplasia: a population-based survey in Norway. Eur J Endocrinol 163:453–459
Reisch N, Hahner S, Bleicken B et al (2011) Quality of life is less impaired in adults with congenital adrenal hyperplasia because of 21-hydroxylase deficiency than in patients with primary adrenal insufficiency. Clin Endocrinol (Oxf) 74:166–173
Vercoulen JH, Swanink CM, Galama JM et al (1998) The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. J Psychosom Res 45:507–517
Servaes P, Verhagen S, Bleijenberg G (2002) Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 13:589–598
Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G (1994) Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 38:383–392
Reisch N, Arlt W (2009) Fine tuning for quality of life: 21st century approach to treatment of Addison’s disease. Endocrinol Metab Clin North Am 38:407–418
Arlt W, Rosenthal C, Hahner S, Allolio B (2006) Quality of glucocorticoid replacement in adrenal insufficiency: clinical assessment vs. timed serum cortisol measurements. Clin Endocrinol (Oxf) 64:384–389
Tak LM, Cleare AJ, Ormel J et al (2011) Meta-analysis and meta-regression of hypothalamic–pituitary–adrenal axis activity in functional somatic disorders. Biol Psychol 87:183–194
Stikkelbroek NM, Hoefsloot LH, de Wijs IJ, Otten BJ, Hermus AR, Sistermans EA (2003) CYP21 gene mutation analysis in 198 patients with 21-hydroxylase deficiency in The Netherlands: six novel mutations and a specific cluster of four mutations. J Clin Endocrinol Metab 88(8):3852–3859
Hermus AR, Zelissen PM (1998) Diagnosis and therapy of patients with adrenocortical insufficiency. Ned Tijdschr Voor Geneeskd 142(17):944–949
Kemink SAG, Frijns JTM, Hermus ARMM, Pieters GFFM, Smals AGH, Lichtenbelt WDV (1999) Body composition determined by six different methods in women bilaterally adrenalectomized for treatment of Cushing’s disease. J Clin Endocrinol Metab 84:3991–3999
Meulenberg PMM, Ross HA, Swinkels LMJW, Benraad ThJ (1987) The effect of oral contraceptives on plasma free and salivary cortisol and cortisone. Clin Chim Acta 165:379–385
Vercoulen JH, Alberts M, Bleijenberg G (1999) De Checklist Individual Strength. Gedragstherapie 32:131–136
Vercoulen JH, Hommes OR, Swanink CM et al (1996) The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol 53:642–649
Beurskens AJ, Bültmann U, Kant I, Vercoulen JH, Bleijenberg G, Swaen GM (2000) Fatigue among working people: validity of a questionnaire measure. Occup Environ Med 57:353–357
Bültmann U, de Vries M, Beurskens AJ, Bleijenberg G, Vercoulen JH, Kant I (2000) Measurement of prolonged fatigue in the working population: determination of a cutoff point for the Checklist Individual Strength. J Occup Health Psychol 5:411–416
van der Werf SP, Prins JB, Vercoulen JH, van der Meer JW, Bleijenberg G (2000) Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. J Psychosom Res 49:373–379
Servaes P, van der Werf S, Prins J, Verhagen S, Bleijenberg G (2001) Fatigue in disease-free cancer patients compared with fatigue in patients with chronic fatigue syndrome. Support Care Cancer 9:11–17
Alberts M, Vercoulen JH, Bleijenberg G (2001) Assessment of fatigue—the practical utility of the subjective feeling of fatigue in research and clinical practice. In: Vingerhoets A (ed) Assessment in behavioural medicine, 1st edn. Brunner-Routledge, Sussex, pp 301–328
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571
Beck AT, Guth D, Steer RA, Ball R (1997) Screening for major depression disorders in medical inpatients with the Beck Depression Inventory. Behav Res Ther 35:785–791
Arindell WA, Ettema JHM (1986) SCL-90, handleiding bij een multidimensionele psychopathologie-indicator (SCL 90, Manual for a Multidimensional Psychopathology Indicator, Dutch version). Swets & Zeitlinger, Lisse
Bergner M, Bobbitt RA, Carter WB, Gilson BS (1981) The Sickness Impact Profile: development and final revision of a health status measure. Med Care 19:787–805
Van der Zee K, Sanderman R (1993) Het meten van de algemene gezondheidstoestand met de RAND-36: Een handleiding (SF-36, Manual Dutch version). Noorderlijk Centrum voor Gezondheidsvraagstukken, Groningen
van Hoogmoed D, Fransen J, Bleijenberg G, van Riel P (2010) Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis. Rheumatology (Oxford) 49:1294–1302
Nordenskjöld A, Holmdahl G, Frisén L et al (2008) Type of mutation and surgical procedure affect long-term quality of life for women with congenital adrenal hyperplasia. J Clin Endocrinol Metab 93:380–386
Gielissen MF, Schattenberg AV, Verhagen CA, Rinkes MJ, Bremmers ME, Bleijenberg G (2007) The experience of severe fatigue in long term survivors of stem cell transplantation. Bone Marrow Transplant 39:595–603
Chambers D, Bagnall AM, Hempel S, Forbes C (2006) Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med 99:506–520
Edmonds M, McGuire H, Price JR (2004) Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev (3), Art no. CD003200. doi:10.1002/14651858.CD003200.pub2
Moss-Morris R, Sharon C, Tobin R, Baldi JC (2005) A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. J Health Psychol 10:245–259
Wiborg JF, Knoop H, Stulemeijer M, Prins JB, Bleijenberg G (2010) How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med 40:1281–1287
Conflict of interest
V. Giebels, H. Repping-Wuts, G. Bleijenberg, J.M. Kroese, N. Stikkelbroeck, A. Hermus declare they have no conflict of interest.
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V. Giebels and H. Repping-Wuts have contributed equally to this manuscript.
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Giebels, V., Repping-Wuts, H., Bleijenberg, G. et al. Severe fatigue in patients with adrenal insufficiency: physical, psychosocial and endocrine determinants. J Endocrinol Invest 37, 293–301 (2014). https://doi.org/10.1007/s40618-013-0042-9
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DOI: https://doi.org/10.1007/s40618-013-0042-9