Tokumasu, Kazuki, Ochi, Kanako, Otsuka, Fumio · BMJ case reports · 2021 · DOI
This case describes a 42-year-old man who was told he had chronic fatigue syndrome (CFS) and fibromyalgia, but was actually missing two important hormones: cortisol and growth hormone. When doctors tested his pituitary gland (which makes these hormones), they found deficiencies that weren't caught before. After starting treatment with these hormones, his severe tiredness, muscle pain, and depression all improved significantly.
This case is important because it demonstrates that some patients diagnosed with CFS may actually have treatable hormone deficiencies that are being missed. It suggests that ME/CFS patients should be screened for pituitary hormone deficiencies, as correcting these deficiencies led to significant symptom improvement in this patient. This highlights the need for comprehensive endocrinological evaluation in CFS diagnostic workups.
This single case report does not prove that hormone deficiencies cause CFS broadly or establish how common this condition is in CFS populations. It does not demonstrate that all CFS patients would benefit from hormone screening, nor does it establish whether the hormone deficiency was the primary cause of the patient's symptoms or a separate contributing condition. Larger studies are needed to determine if this finding applies beyond individual cases.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Tokumasu, Kazuki, Ochi, Kanako, & Otsuka, Fumio (2021). Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome.. BMJ case reports. https://doi.org/10.1136/bcr-2021-244861
BibTeX
@article{mecfsatlas-tokumasu-2021-idiopathic-combined,
author = {Tokumasu, Kazuki and Ochi, Kanako and Otsuka, Fumio},
title = {Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome.},
journal = {BMJ case reports},
year = {2021},
doi = {10.1136/bcr-2021-244861},
note = {PubMed: 34686480},
url = {https://www.mecfsatlas.com/evidence/tokumasu-2021-idiopathic-combined},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/tokumasu-2021-idiopathic-combined
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