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Severe fatigue in patients with adrenal insufficiency: physical, psychosocial and endocrine determinants

Journal of Endocrinological Investigation Aims and scope Submit manuscript

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.

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Fig. 1

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

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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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Correspondence to H. Repping-Wuts.

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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

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