title: Abnormal thermoregulatory responses in adolescents with chronic fatigue syndrome: relation to clinical symptoms.
abstract: OBJECTIVE
  Chronic fatigue syndrome is a common and disabling disease of unknown etiology. Accumulating evidence indicates dysfunction of the autonomic nervous system. To further explore the pathophysiology of chronic fatigue syndrome, we investigated thermoregulatory responses dependent on catecholaminergic effector systems in adolescent patients with chronic fatigue syndrome.
  
  
  METHODS
  A consecutive sample of 15 patients with chronic fatigue syndrome aged 12 to 18 years and a volunteer sample of 57 healthy control subjects of equal gender and age distribution were included. Plasma catecholamines and metanephrines were measured before and after strong cooling of 1 hand. Acral skin blood flow, tympanic temperature, heart rate, and mean blood pressure were measured during moderate cooling of 1 hand. In addition, clinical symptoms indicative of thermoregulatory disturbances were recorded.
  
  
  RESULTS
  Patients with chronic fatigue syndrome reported significantly more shivering, sweating, sudden change of skin color, and feeling unusually warm. At baseline, patients with chronic fatigue syndrome had higher levels of norepinephrine, heart rate, epinephrine, and tympanic temperature than control subjects. During cooling of 1 hand, acral skin blood flow was less reduced, vasoconstrictor events occurred at lower temperatures, and tympanic temperature decreased more in patients with chronic fatigue syndrome compared with control subjects. Catecholamines increased and metanephrines decreased similarly in the 2 groups.
  
  
  CONCLUSIONS
  Adolescent patients with chronic fatigue syndrome have abnormal catecholaminergic-dependent thermoregulatory responses both at rest and during local skin cooling, supporting a hypothesis of sympathetic dysfunction and possibly explaining important clinical symptoms.
authors.affiliation: Department of Pediatrics, Rikshospitalet-Radiumhospitalet Medical Center, N-0027 Oslo, Norway. brwylle@online.no
authors.forename: Vegard Bruun
authors.initials: VB
authors.lastname: Wyller
authors.forename: Kristin
authors.initials: K
authors.lastname: Godang
authors.forename: Lars
authors.initials: L
authors.lastname: Mørkrid
authors.forename: Jerome Philip
authors.initials: JP
authors.lastname: Saul
authors.forename: Erik
authors.initials: E
authors.lastname: Thaulow
authors.forename: Lars
authors.initials: L
authors.lastname: Walløe
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D001831:Body Temperature; D001833:Body Temperature Regulation; D002395:Catecholamines / Q000097:blood; D002648:Child; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology*; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008676:Metanephrine / Q000097:blood; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply; D014661:Vasoconstriction
chemical_list: D002395:Catecholamines; D008676:Metanephrine