I have been treating this patient for a few months. This 42 year old female came to see me for a Lyme evaluation. Lyme didn't seem likely, but since her husband suffers with chronic Lyme disease she decided to check out this possibility. Her chief complaint was fatigue. She carried the diagnosis of chronic fatigue syndrome.
She feels she has been tired her entire life, at least since age 19. At age 20 she was diagnosed with depression. Various antidepressants were prescribed with minimal benefit. A sleep study(polysomnogram) was negative. The MSLT, multiple sleep latency test was slight abnormal but did not meet the criteria for narcolepsy. She has been treated with 600 mg of Nuvigil( a very high dose), without any benefit - this is unusual. Her symptoms had become significantly worse over the last year. She had episodes of profound fatigue and perhaps weakness of her legs. At times it was difficult for her to get out of bed in the morning. Other symptoms included: mild brain fog, rare knee pain and some numbness and tingling. She had a history of night sweats which stopped one year ago. She had persistent loose stools, short of diarrhea. She has been seeing a psychiatrist for years. Recently anxiety has become worse along with panic attacks. She complained of the inability to accomplish tasks, difficulty handling stress, and indecisiveness.
Lab tests showed serological positivity to Babesia microti and Lyme. In addition, there was evidence of adrenal dysfunction. The ACTH level was very high, 98, while the cortisol level was 14, within the normal range.
In addition to chronic Lyme disease I felt she suffered with adrenal fatigue. The diagnosis is associated with dysfunction of the hypothalamic's-pituitary-adrenal axis. The ACTH level should not have been elevated in the face of a normal cortisol level.
Her treatment then included: typical antibiotics - plus Cortef. After only 6 weeks she claimed that "this was the best she had felt in years!" She states she now feels normal. Gone were fatigue and cognitive symptoms.She was incredulous, as were her psychiatrist and sleep specialist. Side effects of therapy included, nausea and constipation - surprisingly, rather than diarrhea.
In patients who have been chronically ill for years or even decades, adrenal fatigue must be considered along with other potential causes. Patients with chronic fatigue syndrome should always have sleep studies including the MSLT and be evaluated for gluten sensitivity, thyroid disease, and a variety of other disorders.
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