Addison's Disease vs. Chronic Fatigue Syndrome: Recognizing Signs of Adrenal Insufficiency and Hypocortisolism

The Addison's disease and chronic fatigue syndrome are two medical conditions that, although distinct in their etiology, share a series of symptoms that can lead to confusion in diagnosis. Both can present with severe fatigue, hypotension, and other nonspecific symptoms that complicate their clinical differentiation. In this article, we will explore how to recognize the signs of adrenal insufficiency and distinguish them from chronic fatigue syndrome.

Recognizing the Signs of Adrenal Insufficiency

Adrenal insufficiency, also known as hypocortisolism, is a condition in which the adrenal glands do not produce enough hormones, particularly cortisol. Symptoms include chronic fatigue, weight loss, skin hyperpigmentation, hypotension, and electrolyte imbalances such as hyponatremia and hyperkalemia. An accurate diagnosis requires a serum cortisol analysis, especially in the morning, and ACTH stimulation tests to confirm cortisol deficiency.

In contrast, chronic fatigue syndrome is characterized by persistent fatigue that is not relieved by rest and cannot be explained by an underlying medical condition. Although it shares symptoms with Addison's disease, such as fatigue and hypotension, it does not present the characteristic hormonal alterations of adrenal insufficiency. A study suggests that the lack of endocrinologists in multidisciplinary working groups may have contributed to the omission of the relationship between these conditions in recent clinical reports [1].

Patient education is crucial for the management of adrenal insufficiency. Educational programs should focus on the early identification of signs of adrenal crisis and the proper administration of glucocorticoids [2]. Additionally, it is important to consider other rare causes of adrenal insufficiency, such as POEMS syndrome, which may present with endocrine and neurological symptoms [3].

Conclusions

Differentiating between Addison's disease and chronic fatigue syndrome is essential for appropriate treatment. While both share symptoms such as fatigue and hypotension, the presence of hypocortisolism and electrolyte imbalances are indicative of adrenal insufficiency. An accurate diagnosis and proper management can significantly improve the quality of life for patients. Interdisciplinary collaboration and ongoing education are fundamental to optimizing the care of these patients.

Referencias

• [1] Chronic fatigue syndrome: an endocrine disease off limits for endocrinologists?
• [2] Group 6. Modalities and frequency of monitoring of patients with adrenal insufficiency. Patient education
• [3] POEMS syndrome: a rare cause of adrenal insufficiency in a young male

Created 6/1/2025