Chronic Fatigue Syndrome

Extreme fatigue that is ongoing and cannot be explained by a medical condition or has no other scientifically proven cause is called Chronic Fatigue Syndrome or CFS. Chronic Fatigue Syndrome can be detrimental to a person’s ability to perform and complete even the most basic daily or routine tasks and activities.

As there is currently no definitive test to diagnose CFS, laboratory testing is used to eliminate and provide treatment options for health conditions or disorders with similar symptoms. The CDC provides guidelines for the basic tests that should be performed, but these could be dependent on other symptoms as well as the health care practitioner managing the case.

Laboratory Tests For Exclusion Purposes

A Comprehensive Metabolic Panel (CMP) includes a variety of different tests to determine the health of organs and identify a range of health conditions such as kidney and liver disease.

A Complete Blood Count (CBC) evaluates blood disorders specifically to look for infection or anemia and other conditions.

C-reactive Protein or Erythrocyte Sedimentation rate, which acts as indicators of nonspecific inflammation in the body.

Thyroid Stimulating Hormone (TSH), including other types of thyroid testing for hypothyroidism.

Iron Studies to detect anemia or an iron deficiency.

Urinalysis to identify infections or other conditions.

Any additional tests that a medical practitioner deems necessary in identifying diseases or health conditions or excluding them as causes of the symptoms of CFS. These additional tests may include:

Antinuclear Bodies (ANA) to identify autoimmune disorders.

Lyme disease tests if the disease is suspected, and the geographical area gives cause for testing.

Rheumatoid Factor to detect Rheumatoid Arthritis.

HIV Antibody Test to identify or eliminate an HIV infection.

Cortisol Testining to identify low concentrations of cortisol as well as adrenal gland function.

SEE BELOW THE LIST OF TESTS FOR MORE INFORMATION ABOUT Chronic Fatigue Syndrome


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Antinuclear antibodies are associated with rheumatic diseases including Systemic Lupus Erythematous (SLE), mixed connective tissue disease, Sjogren's syndrome, scleroderma, polymyositis, CREST syndrome, and neurologic SLE. 

Reflex Information: If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge.


Increased CRP levels are found in inflammatory conditions including: bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

There is a correlation between increased risk of premature heart disease with decreasing size of LDL particles. Ion mobility offers the only direct measurement of lipoprotein particle size and concentration for each lipoprotein from HDL3 to large VLDL.

Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor abosrption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia. This assay employs liquid chromatography tandem mass spectrometry to independently measure and report the two common forms of 25-hydroxy vitamin D: 25OH D3 - the endogenous form of the vitamin and 25OH D2 - the analog form used to treat 25OH Vitamin D3 deficiency.





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CoQ10 (Coenzyme Q10)

Coenzyme Q10 (CoQ10) is a substance similar to a vitamin. It is found in every cell of the body. Your body makes CoQ10, and your cells use it to produce energy your body needs for cell growth and maintenance. It also functions as an antioxidant, which protects the body from damage caused by harmful molecules.


A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)


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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency). Patient needs to have the specimen collected between 7 a.m.-9 a.m.


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Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency).

  • Cardio IQ Vitamin D, 25-Hydroxy, LC/MS/MS [ 91735 ]
  • Coenzyme Q10 [ 19826 ]
  • Ferritin [ 457 ]
  • Glucose [ 483 ]
  • Insulin [ 561 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Magnesium, RBC [ 623 ]
  • Selenium [ 5507 ]
  • TSH [ 899 ]
  • Vitamin A (Retinol) [ 921 ]
  • Vitamin B1 (Thiamine), Blood, LC/MS/MS [ 5042 ]
  • Vitamin B12 (Cobalamin) and Folate Panel, Serum [ 7065 ]
  • Vitamin B2, Plasma [ 36399 ]

Elevated levels of serum erythropoietin (EPO) occur in patients with anemias due to increased red cell destruction in hemolytic anemia and also in secondary polycythemias associated with impaired oxygen delivery to the tissues, impaired pulmonary oxygen exchange, abnormal hemoglobins with increased oxygen affinity, constriction of the renal vasculature, and inappropriate EPO secretion caused by certain renal and extrarenal tumors. Normal or depressed levels may occur in anemias due to increased oxygen delivery to tissues, in hypophosphatemia, and in polycythemia vera.


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Useful in the diagnosis of hypochromic, microcytic anemias. Decreased in iron deficiency anemia and increased in iron overload.


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Serum glucose levels may be abnormally high (hyperglycemia) or abnormally low (hypoglycemia). Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolic disorders including diabetes mellitus, idiopathic hypoglycemia, and pancreatic islet cell neoplasm.

A Hemoglobin (Hb) A1c Blood Test evaluates the average amount of glucose in the blood. The A1c test will help determine whether you are at a higher risk of developing diabetes; to help diagnose diabetes and prediabetes; to monitor diabetes and to aid in treatment decisions.

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.


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Insulin-like growth factor I (IGF-I, or somatomedin C), a protein involved in stimulating somatic growth, is regulated principally by growth hormone (GH) and nutritional intake. IGF-I is transported in serum by several proteins; this helps maintain relatively high IGF-I plasma levels and minimizes fluctuations in serum IGF-I concentrations. Measuring IGF-I is useful in several growth-related disorders. Dwarfism caused by deficiency of growth hormone (hypopituitarism) results in decreased serum levels of IGF-I, while acromegaly (growth hormone excess) results in elevated levels of IGF-I. IGF-I measurements are also helpful in assessing nutritional status; levels are reduced in undernutrition and restored with a proper diet.

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For diagnosis and monitoring of diabetes and insulin-secreting tumors.

Serum iron quantification is useful in confirming the diagnosis of iron-deficiency anemia or hemochromatosis. The measurement of total iron binding in the same specimen may facilitate the clinician''s ability to distinguish between low serum iron levels caused by iron deficiency from those related to inflammatory neoplastic disorders. The assay for iron measures the amount of iron which is bound to transferrin. The total iron binding capacity (TIBC) measures the amount of iron that would appear in blood if all the transferrin were saturated with iron. It is an indirect measurement of transferri

Lyme disease is transmitted by a tick vector carrying Borrelia burgdorferi. Immunoblot testing qualitatively examines, with high specificity, antibodies in a patient's specimen. Immunoblot testing is appropriate for confirming a detected EIA or IFA test result.

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Elevated RF is found in collagen vascular diseases such as SLE, rheumatoid arthritis, scleroderma, Sjögren's Syndrome, and in other conditions such as leprosy, tuberculosis, syphilis, malignancy, thyroid disease and in a significant percentage of otherwise normal elderly patients.


Extreme fatigue that is ongoing and cannot be explained by a medical condition or has no other scientifically proven cause is called Chronic Fatigue Syndrome or CFS. Chronic Fatigue Syndrome can be detrimental to a person’s ability to perform and complete even the most basic daily or routine tasks and activities.

Even though a person is continuously fatigued, they have trouble sleeping and often wake to feel as if they have not slept at all.

Other symptoms that they may experience include:

  • Recurrent headaches
  • Pain in the joints and muscles
  • Frequent sore throat
  • Problems with memory, focus, and concentration

Not every person may experience all these symptoms and may be affected to varying degrees, which may change from day to day. In extreme cases, CFS can last for an extended period exceeding six months. A person may be able to function almost normally on days when the symptoms are mild but on bad days, may not be able to get out of bed at all. Resting and sleeping do not resolve chronic fatigue, and mental activity may increase the symptoms.

CFS can affect any person regardless of age, gender, ethnicity, or economic standing anywhere in the world. However, the disorder is estimated to be four times as prevalent in females than in males and in those between the ages of 40 and 50 years. The CDC (Centers for Disease Control and Prevention) has estimated that around 1 million people in the United States have CFS. However, only around 20% of these know that they have the disorder and have been formally diagnosed.

Currently, there is very little known about the cause of CFS. Although a single cause has not been identified, scientific research has revealed several different triggers that include the following:

  • Although no specific microbe has been attributed to the cause of CFS, viral infections like the Epstein Barr Virus may trigger the condition
  • Trauma, stress, or allergies that result in immune dysfunction may, in turn, trigger CFS
  • Malnourishment or nutritional deficiencies
  • Neurally mediated hypotension or extremely low blood pressure causing fainting may be a trigger
  • Disturbances in the hypothalamic-pituitary-adrenal (HPA) axis, which may result from inactivity, psychiatric comorbidity, extended stress, disturbances in sleep patterns, and medication
  • After studying familial CFS patterns, researchers believe that there may be a genetic component that would make certain people more predisposed to the disorder

Current research points to CFS being a group of disorders that all result in the same symptoms rather than a singular condition. However, more research is required for scientific confirmation.

A definitive group of onset symptoms has been identified by those who have been diagnosed with CFS. In other words, specific symptoms that they experienced during a time when they had the required energy to function and complete routine tasks. It has been concluded that around 75% of the time, CFS patients experience what appear to be flu-like symptoms. In other patients, CFS followed an extended or extreme period of mental or physical stress. The symptoms of CFS also develop slowly, resulting in a gradual decline in energy levels and overall wellbeing.

There are, however, several illnesses, diseases, and health conditions that may present with a similar set of symptoms and side effects but must be distinguished from CFS. These conditions are the underlying cause of chronic fatigue and may be short or long-term. Some diseases that may present with chronic fatigue but must exclude a diagnosis of CFS include:

  • Hypothyroidism or thyroid that is under-performing
  • Mononucleosis commonly called mono
  • Psychological disorders or mental health conditions
  • Eating disorders like anorexia or bulimia
  • Cancer and cancer treatments
  • Autoimmune diseases
  • Infection
  • Abuse or addiction to substances such as drugs and alcohol
  • Side effects or reactions to prescription medications
  • An inability to achieve enough uninterrupted sleep

Unfortunately, there is currently no single evaluation or test that can be used to diagnose CFS accurately. The signs and symptoms of the disorder are used as qualifying criteria to reach a diagnosis.

Signs And Symptoms Of CFS

On conjunction with a panel of international expert researchers, the CDC have established a definition for Chronic Fatigue Syndrome and a list of signs and symptoms that therefore define the disorder:

  • Severe chronic fatigue must last for a minimum period of 6 consecutive months or longer without any known medical conditions having been previously clinically diagnosed
  • The ability to perform basic or routine daily tasks must be severely affected

A minimum of four of the following eight symptoms must occur during the six-month period, either ongoing or on a recurring basis:

  • An inability to concentrate, shortened attention span, and impaired short-term memory
  • Frequent or persistent sore throat
  • Lymph nodes in the neck or armpits that are sore and tender
  • Pain in muscles
  • Multiple joint pain that is unaccompanied by inflammation (swelling) and/or redness
  • Unfamiliar headaches, more extreme or occurring in new patterns
  • Waking up feeling unrefreshed
  • Extreme fatigue that lasts more than 24 hours after mental or physical activity

The National Academy of Medicine Committee on Diagnostic Criteria for Myalgic Encephalomyelitis (Chronic Fatigue Syndrome) released additional diagnostic criteria in a report for CFS to improve on the existing criteria for diagnosis and care of those who are suffering from the health condition. Some of the criteria are similar or the same as those that have been outlined above. Additional criteria that medical practitioners can use to diagnose the ME or CFS accurately include:

  • Extreme fatigue must be new and be present for more than six months, defined by a specific beginning. It should not have been caused by excessive exercise and cannot be improved by resting. It must affect the ability to perform basic daily activities such as work, school personal hygiene to a certain degree.
  • It must negatively impact general wellbeing and present with a general feeling of malaise (illness), which is increased after expending energy

One of the following symptoms should also be present at least 50% of the time, and it must be determined how severe and how often they occur:

  • Cognitive Impairment resulting in an inability to concentrate for a period of time, a short attention span as well as problems with memory
  • Orthostatic Intolerance is feeling dizzy or light-headed or having heart palpitations when rising from a sitting or resting position that could result in faintness or fainting

The less common side effects and symptoms of CFS include:

  • Gastrointestinal conditions such as abdominal pain, bloating, loss of appetite, nausea, and/or vomiting
  • Sensitivity or an adverse reaction (allergic reaction) to certain foods, odors, sounds, medications, or chemicals
  • Night sweats or chills
  • Constant or consistent (chronic) coughing
  • Anxiety and/or depression
  • Frequent urination
  • Sensitivity to cold and heat
  • Lowered body temperature
  • Dry mouth and eyes
  • Earache
  • TMJ (Temporomandibular Joint) dysfunction or pain in the jaw
  • Mild fever
  • Stiff joints, particularly in the mornings
  • A sensation of numbness, tingling, or burning in the extremities (hands and feet) and the face
  • Shortness of breath

Tests For CFS

As there are currently no specific blood tests, imaging scans, or other means of an accurate diagnosis for chronic fatigue syndrome, diagnosis is one of exclusion. This means that all illnesses, disease, or other health conditions that may present with similar symptoms must be excluded before arriving at a diagnosis of CFS.

Diagnosis will, therefore, involve the following:

  • Detailed documentation of the medical history of a patient
  • A thorough medical examination
  • Performing cognitive function tests
  • Excluding any other conditions that may be causing or aggravating fatigue as well as providing treatment for those conditions that can be treated
  • Ensuring that the condition fulfills the criteria to meet the CDC definition and/or National Academy of Medicine criteria
  • Monitoring of a patient over a period of time to evaluate whether there may be any other underlying causes

Classification of idiopathic or unknown chronic fatigue will be made should the condition fail to meet the CDC definition or the National Academy of Medicine criteria or where the symptoms are not severe enough to warrant a diagnosis of CFS.

As there is currently no definitive test to diagnose CFS, laboratory testing is used to eliminate and provide treatment options for health conditions or disorders with similar symptoms. The CDC provides guidelines for the basic tests that should be performed, but these could be dependent on other symptoms as well as the health care practitioner managing the case.

Laboratory Tests For Exclusion Purposes

A Comprehensive Metabolic Panel (CMP) includes a variety of different tests to determine the health of organs and identify a range of health conditions such as kidney and liver disease.

A Complete Blood Count (CBC) evaluates blood disorders specifically to look for infection or anemia and other conditions.

C-reactive Protein or Erythrocyte Sedimentation rate, which acts as indicators of nonspecific inflammation in the body.

Thyroid Stimulating Hormone (TSH), including other types of thyroid testing for hypothyroidism.

Iron Studies to detect anemia or an iron deficiency.

Urinalysis to identify infections or other conditions.

Any additional tests that a medical practitioner deems necessary in identifying diseases or health conditions or excluding them as causes of the symptoms of CFS. These additional tests may include:

Antinuclear Bodies (ANA) to identify autoimmune disorders.

Lyme disease tests if the disease is suspected, and the geographical area gives cause for testing.

Rheumatoid Factor to detect Rheumatoid Arthritis.

HIV Antibody Test to identify or eliminate an HIV infection.

Cortisol Testineg to identify low concentrations of cortisol as well as adrenal gland function.