{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:10:18Z","timestamp":1756275018543,"version":"3.44.0"},"reference-count":25,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,10,7]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2021-244861","type":"journal-article","created":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T10:50:24Z","timestamp":1634899824000},"page":"e244861","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Idiopathic combined adrenocorticotropin and growth hormone deficiency mimicking chronic fatigue syndrome"],"prefix":"10.1136","volume":"14","author":[{"given":"Kazuki","family":"Tokumasu","sequence":"first","affiliation":[{"name":"Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanako","family":"Ochi","sequence":"additional","affiliation":[{"name":"Center for Education in Medicine and Health Sciences, 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