van der Meer, J W, Elving, L D · Nederlands tijdschrift voor geneeskunde · 1997
This study describes two patients with severe tiredness. One woman had chronic fatigue syndrome and improved slowly over time, while one man's exhaustion was caused by a treatable pituitary gland tumor that was removed surgically. The doctors emphasize that it's important to thoroughly examine patients to find out if something else is causing their tiredness before diagnosing chronic fatigue syndrome.
This study underscores the critical importance of differential diagnosis in chronic fatigue presentations, reminding clinicians that some cases of severe fatigue have treatable underlying causes that may be missed if diagnostic criteria are applied too rigidly. It also provides early evidence that CFS prognosis is not uniformly poor, with a meaningful proportion of patients experiencing significant improvement.
This study does not establish the prevalence, incidence, or natural history of ME/CFS, nor does it provide evidence about treatment efficacy. Two case reports cannot determine whether the diagnostic criteria mentioned are adequate or inadequate, and the prognosis data (20% improvement over 18 months) is based on limited data without details about what 'significant improvement' entails or how outcomes were measured.
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 →
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