Hypothalamic–pituitary–adrenal axis dysfunction in chronic fatigue syndrome

  title={Hypothalamic–pituitary–adrenal axis dysfunction in chronic fatigue syndrome},
  author={Andrew S. Papadopoulos and Anthony J. Cleare},
  journal={Nature Reviews Endocrinology},
The weight of current evidence supports the presence of the following factors related to hypothalamic–pituitary–adrenal (HPA) axis dysfunction in patients with chronic fatigue syndrome (CFS): mild hypocortisolism; attenuated diurnal variation of cortisol; enhanced negative feedback to the HPA axis; and blunted HPA axis responsiveness. Furthermore, HPA axis changes seem clinically relevant, as they are associated with worse symptoms and/or disability and with poorer outcomes to standard… 

A Review of Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome

Given the interindividual variation in the effectiveness of existing biological and psychological treatments, the need for novel treatment strategies such as those which target the HPA axis is clear.

Hypothalamic-Pituitary-Adrenal (HPA) Axis and Chronic Fatigue Syndrome in Older Adults: The Rehabilitation Perspectives

With proper coaching and regular facilitation regarding AS, activity participation in older adults with CFS can be greatly enhanced, and Behavioral intervention, such as AS, can supplement therapeutic treatment or may lead to decline in CFS symptoms.

Neuroendocrine disorder in chronic fatigue syndrome

One-time hormone measurement is not sufficient to detect hormonal imbalance in women suffering from CFS, and absence of a correlation between afternoon and morning cortisol level could be a more representative factor for detecting HPA axis disturbance.

Early-life stress and HPA axis trigger recurrent adulthood depression

Altered neuroendocrine control and association to clinical symptoms in adolescent chronic fatigue syndrome: a cross-sectional study

Different interrelation between hormones of the HPA axis, the SAM system, and the thyroid system in CFS patients and healthy controls is revealed, and an association between hormone control characteristics and important clinical variables in the CFS group is found.

Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways

Findings show that activation of immune-inflammatory and O&NS pathways in ME/CFS are probably not secondary to HPA axis hypoactivity and thatactivation of these pathways may underpin HPA Axis hypofunction in ME /CFS.

Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation

Three hypothalamic mechanisms of fatigue in multiple sclerosis are discussed: general hypothalamic-pituitary-adrenal axis hyperactivity, disordered orexin neurotransmission, and potential mechanisms of weight dysregulation caused by hypothalamic dysfunction.



The HPA axis and the genesis of chronic fatigue syndrome

  • A. Cleare
  • Psychology
    Trends in Endocrinology & Metabolism
  • 2004

Combined dexamethasone/corticotropin-releasing factor test in chronic fatigue syndrome

CFS is globally associated with reduced cortisol responses in the combined low-dose dexamethasone/corticotropin-releasing factor test, but this effect is only clearly present in CFS patients without a history of ELS, which provides further support for an enhanced glucocorticoid negative feedback and/or a reduced central HPA axis drive in C FS.

Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome.

Although it cannot definitively account for the etiology of the mild glucocorticoid deficiency seen in chronic fatigue syndrome patients, the enhanced adrenocortical sensitivity to exogenous ACTH and blunted ACTH responses to oCRH are incompatible with a primary adrenal insufficiency.

Salivary cortisol response to awakening in chronic fatigue syndrome

This naturalistic test of the HPAaxis response to stress showed impaired HPA axis function in CFS, with lower cortisol response to awakening.

24-Hour Pituitary and Adrenal Hormone Profiles in Chronic Fatigue Syndrome

Patients with CFS demonstrated subtle alterations in HPA axis activity characterized by reduced ACTH over a full circadian cycle and reduced levels during the usual morning physiological peak ACTH secretion, providing further evidence of subtle dysregulation of the H PA axis in CFS.

Diurnal patterns of salivary cortisol and cortisone output in chronic fatigue syndrome.

Cortisol and hypothalamic–pituitary–gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and effect of depressive symptoms on these hormones

It is suggested that in spite of low morning cortisol concentrations, the only abnormalities in hypothalamic–pituitary–gonadal axis hormones among follicular-phase women with fibromyalgia or CFS are those of LH levels in Fibromyalgia patients with a low BDI score, which must be taken into account in future investigations.