Cleare, Anthony J · Endocrine reviews · 2003 · DOI
This review examined how hormones—particularly the stress hormone cortisol and others made by the brain and glands—may be altered in ME/CFS patients. The researchers found that some patients have lower cortisol levels than expected, and their bodies may respond differently to stress, but these changes vary significantly from person to person. The review suggests that many factors like inactivity, poor sleep, and ongoing stress likely contribute to these hormone changes rather than a single cause.
Understanding hormonal abnormalities in ME/CFS is crucial because the HPA axis regulates stress response, energy production, and immune function—all impaired in this disease. This review identifies that hormone changes may contribute to symptom persistence and highlights the need for more rigorous prospective studies to establish whether correcting these abnormalities could improve patient outcomes.
This review does not prove that HPA axis dysfunction is the primary cause of ME/CFS or that it occurs uniformly in all patients. The presence of hormonal changes does not establish whether they are causing symptoms or are secondary consequences of the disease and its associated factors like inactivity and sleep disruption. The heterogeneity of findings means no single hormonal pattern defines ME/CFS.
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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