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To the Editor.—In his discussion about chronic fatigue syndrome (CFS), Dr Komaroff1 states that, in addition to symptoms included in the case definition, many patients with CFS also frequently report anorexia, nausea, and dizziness. Counting these latter symptoms, which have also been found in adrenal insufficiency,2 CFS shares 23 features with Addison disease,3 including both the symptoms of the case definition for CFS and all the neuropsychological complaints that have led some people to claim that CFS is just a manifestation of an underlying depression. Considering that no medical condition except Addison disease shares more than 20 features with CFS, it is unclear why no study to my knowledge has been performed to determine whether the treatment for Addison disease, ie, hydrocortisone plus fludrocortisone acetate, could also benefit CFS patients. Fludrocortisone is likely to be of benefit based on a previous study in patients with CFS.4
Komaroff claims that CFS occurs in all ethnic and racial groups. African Americans, however, rarely seem to develop CFS.3
As Komaroff points out, depressed function of natural killer cells represents one of the most robust findings in CFS. In view of the fact that natural killer cell activity is directly associated with the circadian rhythm of cortisol,5 it can be reasonably suggested that the depressed function of natural killer cells in CFS patients simply mirrors their hypocortisolism.3 This explanation is in accord with the opinion that the chronic immune activation observed in CFS does not occur because of an infectious agent, but because of a mere lack of steroid restraint on the immune system.3
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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