Jerjes, Walid K, Taylor, Norman F, Peters, Timothy J et al. · Psychosomatic medicine · 2006 · DOI
This study measured stress hormone levels in urine from people with ME/CFS and healthy controls to see if ME/CFS patients produce less cortisol (a hormone made during stress). The researchers found no major difference in total cortisol output between the two groups when measuring both cortisol and its breakdown products, though free cortisol levels were slightly lower in patients and related to fatigue severity.
This study challenges the hypothesis that ME/CFS is primarily a state of abnormally low cortisol production, suggesting instead that cortisol metabolism may be altered. Understanding HPA axis function in ME/CFS is crucial because the hypothalamic-pituitary-adrenal system regulates immune response, energy metabolism, and stress tolerance—all dysregulated in this disease.
This study does not prove that cortisol metabolism is definitively abnormal in ME/CFS, only that total cortisol output measured via urine metabolites is similar to controls. It does not establish causation or explain why cortisol might be cleared faster; nor does it rule out tissue-level cortisol resistance or other HPA axis abnormalities not captured by this measurement method.
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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