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Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome
  1. Kazuki Tokumasu1,
  2. Kanako Ochi2 and
  3. Fumio Otsuka1
  1. 1Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  2. 2Center for Education in Medicine and Health Sciences, Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
  1. Correspondence to Mr Kazuki Tokumasu; tokumasu{at}


A 42-year-old man who had suffered from severe fatigue for 5 years was diagnosed as having chronic fatigue syndrome (CFS) and fibromyalgia. Endocrinological workup using combined anterior pituitary function tests showed that the patient had adrenocorticotropin hormone (ACTH) deficiency, with a normal pituitary MRI. Treatment with a physiologic dose of oral hydrocortisone replacement physically ameliorated his general fatigue. A secondary workup using a growth hormone-releasing peptide-2 test revealed that he also had growth hormone (GH) deficiency, and GH replacement therapy was started. His muscle pain and depression were improved by the therapy. Here, we present a rare case of combined deficiency of ACTH and GH in a middle-aged man with severe general fatigue. This case report aims to raise awareness of combined deficiency of ACTH and GH as a differential diagnosis of CFS and its mimics.

  • general practice / family medicine
  • pituitary disorders
  • adrenal disorders

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  • Contributors All authors contributed to the write-up of this case report. KT and KO provided clinical information and reviewed the final text. KT was also responsible for obtaining patient consent. KO and FO provided information relevant to the investigations. KT wrote the discussion. FO compiled and edited the final text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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