title: Severe fatigue in patients with adrenal insufficiency: physical, psychosocial and endocrine determinants.
abstract: BACKGROUND
  Fatigue is a frequently experienced complaint in patients with adrenal insufficiency (AI) and may be influenced by cortisol levels.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Nijmegen Expert Centre of Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Giebels
authors.forename: H
authors.initials: H
authors.lastname: Repping-Wuts
authors.forename: G
authors.initials: G
authors.lastname: Bleijenberg
authors.forename: J M
authors.initials: JM
authors.lastname: Kroese
authors.forename: N
authors.initials: N
authors.lastname: Stikkelbroeck
authors.forename: A
authors.initials: A
authors.lastname: Hermus
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications* / Q000503:physiopathology; D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012463:Saliva / Q000737:chemistry*; D012720:Severity of Illness Index; D013315:Stress, Psychological
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone