Florinef alone ineffective
Patients with CFS (chronic fatigue syndrome) are more likely than healthy persons to develop neurally mediated hypotension (NMH), where upright posture provokes a dramatic drop in blood pressure. A recent study, published in The Journal of the American Medical Association, found that a steroid hormone drug often used to treat NMH, fludrocortisone (Florinef), is not effective by itself in alleviating the symptoms of CFS patients.

Researchers at Johns Hopkins University School of Medicine and the National Institute of Allergy and Infectious Diseases studied 100 adults with CFS and NMH. Half of the patients received Florinef and half received placebo for nine weeks. Only 14% of those treated with Florinef reported notable improvement compared to 10% in the placebo group.

Researchers caution that lack of symptomatic improvement with Florinef alone does not disprove the hypothesis that NMH could be contributing to  CFS symptoms.

Since 1996 when the study began, other clinical trials found that four different drugs, some of which have a more direct effect on blood pressure than Florinef, can benefit people who experience recurrent fainting due to NMH. Further studies are needed to determine if other NMH medications and therapies are more effective in treating NMH in CFS patients than Florinef alone.

Sleep disorders and CFS
Researchers at Brugmann University Hospital in Brussels, Belgium explored whether primary sleep disorders (PSD) and sleepiness are common in CFS patients. Patients underwent a clinical examination and two nights of all-night monitoring during sleep. Of the 46 CFS patients studied, 54% did not have PSD and 69% had no sleepiness.

While 46% of the CFS patients showed signs of sleep apnea, none were diagnosed with narcolepsy or hypersomnia. No association was found between a sleep disorder and a patient’s clinical status.

Researchers concluded that it is unlikely CFS is a somatic expression of a primary sleep disorder or sleepiness. The full study is published in Sleep Research Online.

CFS genetic link studied
University of Queensland researchers discovered a genetic mutation they believe may, in part, explain what causes CFS. They identified the same gene mutation in 32 members of one Australian family, all of who reportedly have CFS.

The gene regulates the production of cortisol, a hormone released by the adrenal glands in response to stress and which affects immune response.

Dr. David Torpy, a member of the research team, stressed that even if the genetic mutation plays a role in CFS it is unlikely to be the only cause. “However, if this accounts for even one percent of chronic fatigue syndrome sufferers, then it would be a big advance, especially if it is treatable,” he said.

The research team’s findings, which were presented at the 11th International Congress of Endocrinology in Sydney in October, have not yet been published.

Keep in mind that research studies with fewer than 500 patients are generally not considered statistically valid and may be questioned by the medical community. The Chronicle reports on smaller studies due to the lack of large-scale research projects and to keep you updated on emerging trends.