A new view on hypocortisolism
Abstract
Low cortisol levels have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and post-traumatic stress disorder. Data suggest that these disorders are characterized by a symptom triad of enhanced stress sensitivity, pain, and fatigue. This overview will present data on the development, mechanisms and consequences of hypocortisolism on different bodily systems. We propose that the phenomenon of hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress as illustrated in an animal model. Further evidence suggests that despite symptoms such as pain, fatigue and high stress sensitivity, hypocortisolism may also have beneficial effects on the organism. This assumption will be underlined by some studies suggesting protective effects of hypocortisolism for the individual.
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Individuals with MDD have flatter diurnal cortisol slopes, indicating higher overall cortisol concentrations, than persons without MDD.
“In the context of depression, for example, individuals with MDD have been found to have flatter diurnal cortisol slopes (i.e., higher overall cortisol concentrations) than persons without MDD”
From From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. (2014) · cites this paper as Fries, Hesse, Hellhammer, & Hellhammer, 2005
Reduced morning cortisol in chronically stressed individuals may be due to a protective downregulation of the HPA axis to avoid overexposure to stress hormones.
“This may be due to a protective downregulation of the HPA axis to avoid overexposure to stress hormones (43).”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [43]
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- Authors
- Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H.
- Affiliations
- Universität Trier (DE)
- Corresponding author
- Hellhammer, Dirk H.
- ORCID
- Hellhammer, Dirk H.
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2005-11
- Volume
- 30
- Issue
- 10
- Pages
- 1010-1016
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W1968787277
- Cited by
- 1,204
- References
- 5
- Citations by year
- 2026: 30 · 2025: 39 · 2024: 41 · 2023: 39 · 2022: 62 · 2021: 67 · 2020: 73 · 2019: 60 · 2018: 72 · 2017: 70 · 2016: 58 · 2015: 72 · 2014: 79 · 2013: 80 · 2012: 76
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- adrenal insufficiency, chronic stress, hypothalamic-pituitary-adrenal axis, chronic fatigue syndrome, fibromyalgia, post-traumatic stress disorder, stress sensitivity, pain, fatigue
- MeSH terms
- Humans, Hydrocortisone, Immune System, Stress, Psychological, Sympathetic Nervous System
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