Cortisol output in adolescents with chronic fatigue syndrome: pilot study on the comparison with healthy adolescents and change after cognitive behavioural guided self-help treatment. — CFSMEATLAS
Cortisol output in adolescents with chronic fatigue syndrome: pilot study on the comparison with healthy adolescents and change after cognitive behavioural guided self-help treatment.
Rimes, Katharine A, Papadopoulos, Andrew S, Cleare, Anthony J et al. · Journal of psychosomatic research · 2014 · DOI
Quick Summary
This study measured stress hormone (cortisol) levels in teenagers with ME/CFS compared to healthy teenagers. Teenagers with ME/CFS had lower cortisol levels throughout the day than healthy peers. After cognitive behavioural treatment, cortisol levels in the ME/CFS group returned to normal, suggesting the hormonal difference may be reversible.
Why It Matters
This is one of the first studies to document and quantify hypothalamic-pituitary-adrenal (HPA) axis dysfunction in adolescents with ME/CFS, extending prior adult findings to a younger population. The finding that hormonal abnormalities reversed with cognitive behavioural treatment provides evidence that at least some physiological markers of ME/CFS may be modifiable, which has implications for understanding disease mechanisms and treatment potential.
Observed Findings
Adolescents with CFS had significantly lower daily salivary cortisol output (AUC) compared to healthy controls.
No significant difference was found between groups in the cortisol awakening response.
Within the CFS group, lower daily cortisol output was associated with higher perfectionist striving and higher prosocial behaviour.
After cognitive behavioural guided self-help treatment, 21 adolescents with CFS showed a significant increase in daily cortisol output to normal levels at six-month follow-up.
Mild hypocortisolism in adolescent CFS appears reversible with treatment.
Inferred Conclusions
Daily cortisol output is reduced in adolescents with CFS, consistent with findings in adults with CFS.
The associations between low cortisol and perfectionism/prosocial behaviour align with cognitive behavioural models of CFS pathophysiology.
HPA axis dysfunction in CFS may be at least partially reversible through cognitive behavioural intervention.
The mild hypocortisolism observed is not a fixed, permanent feature of the condition.
Remaining Questions
What is the mechanism by which cognitive behavioural treatment normalizes cortisol output in adolescents with CFS?
What This Study Does Not Prove
This study does not prove that low cortisol causes ME/CFS or that it is the primary driver of fatigue symptoms. The association between perfectionism, prosocial behaviour, and low cortisol does not establish causation. The study cannot determine whether the cortisol increase after treatment reflects improvement in ME/CFS per se or is secondary to general recovery from other factors.
Tags
Symptom:Fatigue
Biomarker:Blood Biomarker
Phenotype:Pediatric
Method Flag:PEM Not DefinedWeak Case DefinitionSmall SampleExploratory Only
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 →