Table 2.

Investigation of ME/CFS: tests to be considered when indicated.

Allergic: skin tests, RAST tests, serum tryptase Cardiac: chest x-ray, EKG (ECG), echocardiogram in those with heart murmurs, tilt testing for those with prominent orthostatic symptoms but no hemodynamic abnormalities in the office 10-min standing test Endocrine/metabolic: morning cortisol, FSH, LH, estradiol, testosterone, prolactin, lactate, pyruvate, IGF-1 and IGF-3, thyroid autoantibodies Gastrointestinal: upper GI endoscopy, colonoscopy, gastric emptying study, HIDA scan, ultrasound of gallbladder Gynecological: ultrasound, laparoscopy, ovarian venogram (to evaluate for ovarian varices) Immunological: anti-double stranded DNA, anti-neutrophil cytoplasmic antibodies, quantitative immunoglobulins, functional antibodies, response to pneumococcal vaccination Infectious diseases: infectious mononucleosis, lyme, and other tick-borne diseases (Babesia microti, Anaplasma phagocytophilum, Ehrlichia chaffeensis) in endemic areas Neurological: MRI studies if Chiari malformation, cervical stenosis, tethered spinal cord, or MS are suspected Pulmonary: pulmonary function tests Sleep: polysomnography, multiple sleep latency testing Urological: cystoscopy