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Adrenal Connection
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Hyper-coagulation can cause a hypoadrenal condition (low adrenal levels) as demonstrated by the following studies dealing with antiphospholipid syndrome [APS] [Berg/Hemex described the hypercoagulation seen with CFIDS as a variation of APS].

  • " We suspected microthromboses in the adrenals and secondary bleeding and treated the boy with hydrocortisone, fludrocortisone and phenprocoumon ... Adrenal failure is a rare complication of APS in children with only five cases reported to date."
    "One different hypothesis is due to the unique nature of the vascular anatomy of the adrenal glands since they are rich with arteial supply (3 arteries with up to 60 branches) but limited with venous drainage by a single vein. This however may predispose thrombotic events."
    Adrenal failure followed by status epilepticus and hemolytic anemia in primary antiphospholipid syndrome. Thromb J. 2005 Apr 18;3(1):6. [Full Text] [Editor Note: adrenal failure is rare, low adrenal appears much more likely].
  • "Kidney is the most frequently affected organ, in addition to transplanted kidney grafts, adrenal glands, bladder and testicles." Urologic damage of the primary antiphospholipid syndrome, Arch Esp Urol. 2004 Sep;57(7):707-23.
  • "Thrombosis frequently involved the gastrointestinal system (21 cases, 22.6%), pulmonary system (19 cases, 20.4%), the cerebral vascular system (17 cases, 18.3%), lower limb deep venous system (16 cases, 17.2%), and infrequently coronary arteries or adrenal glands." Clinical analysis of 61 patients with antiphospholipid syndrome, Zhonghua Yi Xue Za Zhi. 2004 Aug 17;84(16):1367-70
    • [Editor: note the following probable pairings:
      •  IBS <-- --> gastrointestinal system,
      • cognitive issues <-- --> cerebral vascular system
  • "Adrenal involvement is described in the anti-phospholipid syndrome and may present in the form of adrenal deficiency in the case of occasionally only microscopic bilateral haemorrhages. " Inaugural unilateral adrenal hematoma of an antiphospholipid syndrome Presse Med. 2004 Mar 27;33(6):385-8.
  • "Patients with catastrophic antiphospholipid syndrome may have massive venous thromboembolism, along with respiratory failure, stroke, abnormal liver enzyme concentrations, renal impairment, adrenal insufficiency, and areas of cutaneous infarction."  Antiphospholipid syndrome.Dis Mon. 2003 Dec;49(12):696-741

Treatment Considerations:

Comment

I am indebted to Cap't Dave Williams for his early evangelism on the Adrenal-CFIDS connection, however, I believe that the adrenal issues are secondary symptoms and not a primary cause of CFIDS. Adrenal insufficiency does not cause hypocoagulation -- however hypercoagulation can cause adrenal insufficiency. This would be consistent with adrenal issues being seen in long term CFIDS patients but not in new CFIDS patients [HPA changes do not occur early in CFS, but appears late.] -- see Aldosterone for more information.

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