Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome

Papadopoulos, Andrew S.; Cleare, Anthony J.

doi:10.1038/nrendo.2011.153

Cited by 280Fibromyalgia and Chronic Fatigue Syndrome ResearchStress Responses and CortisolAdrenal Hormones and Disorders

Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome

Papadopoulos, Andrew S., Cleare, Anthony J.·2012·Nature Reviews Endocrinology

DOI 10.1038/nrendo.2011.153

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Abstract

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 treatments for CFS. Regarding etiology, women with CFS are more likely to have reduced cortisol levels. Studies published in the past 8 years provide further support for a multifactorial model in which several factors interact to moderate HPA axis changes. In particular, low activity levels, depression and early-life stress appear to reduce cortisol levels, whereas the use of psychotropic medication can increase cortisol. Addressing these factors-for example, with cognitive behavioral therapy-can increase cortisol levels and is probably the first-line approach for correcting HPA axis dysfunction at present, as steroid replacement is not recommended. Given what is now a fairly consistent pattern of findings for the type of HPA axis changes found in CFS, we recommend that future work focuses on improving our understanding of the cause and relevance of these observed changes.

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Glucocorticoid receptor mediated negative feedback in chronic fatigue syndrome using the low dose (0.5 mg) dexamethasone suppression test
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STRESS THE BRAIN-BODY CONNECTION
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DHEA and the Brain
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The Effects of Galantamine Hydrobromide Treatment on Dehydroepiandrosterone Sulfate and Cortisol Levels in Patients with Chronic Fatigue Syndrome
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Investigation of the Hypothalamopituitary–Adrenal Axis by Low-Dose (1 μg) Adrenocorticotrophic Hormone Test and Metyrapone Test in Patients With Chronic Fatigue Syndrome
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Baseline Cortisol Levels Predict Treatment Outcomes in Chronic Fatigue Syndrome Nonpharmacologic Clinical Trial
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Chronic Fatigue Syndrome
Cleare, A. J., & Wessely, S. C. (2001) · Encyclopedia of Life Sciences · doi:10.1038/npg.els.0002207 · Cited by 3 · see citing works
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The Functional and Clinical Significance of the 24-Hour Rhythm of Circulating Glucocorticoids
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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review
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“Other chronic conditions have also been associated with HPA axis dysfunction, including CFS and major depression, as has post-traumatic stress disorder (Yehuda et al., 1991; Pariante and Lightman, 2008; Papadopoulos and Cleare, 2012).”
Early-life stress and HPA axis trigger recurrent adulthood depression.
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Long COVID and Post-infective Fatigue Syndrome: A Review
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The High Costs of Low-Grade Inflammation: Persistent Fatigue as a Consequence of Reduced Cellular-Energy Availability and Non-adaptive Energy Expenditure
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Chronic fatigue syndrome and circulating cytokines: A systematic review
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Understanding the Role of Interleukin-6 (IL-6) in the Joint and Beyond: A Comprehensive Review of IL-6 Inhibition for the Management of Rheumatoid Arthritis
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Stress-Related and Circadian Secretion and Target Tissue Actions of Glucocorticoids: Impact on Health
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Prenatal maternal mood is associated with altered diurnal cortisol in adolescence
O’Donnell, K. J., Glover, V. A. S., Jenkins, J., Browne, D. T., Ben‐Shlomo, Y., Golding, J., & O’Connor, T. G. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.01.008 · Cited by 136 · see citing works
The relationship between cortisol, stress and psychiatric illness: New insights using hair analysis
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Self-citation
Neuroendocrine and neurophysiological effects of interleukin 6 in rheumatoid arthritis
Choy, E., & Calabrese, L. H. (2017) · Rheumatology · doi:10.1093/rheumatology/kex391 · Cited by 124 · see citing works
A Review of Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome
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Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways
Morris, G., Anderson, G., & Maes, M. H. J. (2016) · Molecular Neurobiology · doi:10.1007/s12035-016-0170-2 · Cited by 120 · see citing works
Pathological Mechanisms Underlying Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Missailidis, D., Annesley, S. J., & Fisher, P. R. (2019) · Diagnostics · doi:10.3390/diagnostics9030080 · Cited by 119 · see citing works
Fatigue in Patients with Major Depressive Disorder: Prevalence, Burden and Pharmacological Approaches to Management
Ghanean, H., Ceniti, A. K., & Kennedy, S. H. (2018) · CNS Drugs · doi:10.1007/s40263-018-0490-z · Cited by 108 · see citing works
Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms?
Kim, S. E., & Chang, L. (2012) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2012.01993.x · Cited by 119 · see citing works
Bodily distress syndrome: a new diagnosis for functional disorders in primary care?
Budtz-Lilly, A., Schröder, A., Rask, M. T., Fink, P., Vestergaard, M., & Rosendal, M. (2015) · BMC Family Practice · doi:10.1186/s12875-015-0393-8 · Cited by 115 · see citing works
Wearable and Implantable Cortisol‐Sensing Electronics for Stress Monitoring
Ok, J., Park, S., Jung, Y. H., & Kim, T. (2023) · Advanced Materials · doi:10.1002/adma.202211595 · Cited by 120 · see citing works
Cortisol level dysregulation and its prevalence—Is it nature's alarm clock?
Jones, C., & Gwenin, C. D. (2020) · Physiological Reports · doi:10.14814/phy2.14644 · Cited by 112 · see citing works
Screening NK-, B- and T-cell phenotype and function in patients suffering from Chronic Fatigue Syndrome
Curriu, M., Carrillo, J., Massanella, M., Rigau, J., Alegre, J., Puig, J., Garcia-Quintana, A. M., Castro‐Marrero, J., Negredo, E., Clotet, B., et al. (2013) · Journal of Translational Medicine · doi:10.1186/1479-5876-11-68 · Cited by 105 · see citing works
Interleukin-1 as a mediator of fatigue in disease: a narrative review
Roerink, M. E., van der Schaaf, M. E., Dinarello, C. A., Knoop, H., & van der Meer, J. W. M. (2017) · Journal of Neuroinflammation · doi:10.1186/s12974-017-0796-7 · Cited by 102 · see citing works
Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: A systematic review and subset meta-analysis
Powell, D., Liossi, C., Moss-Morris, R. E., & Schlotz, W. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.07.004 · Cited by 95 · see citing works
Cortisol levels in children with Attention-Deficit/Hyperactivity Disorder
Isaksson, J., Nilsson, K. W., Nyberg, F., Hogmark, Å., & Lindblad, F. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.08.021 · Cited by 94 · see citing works
Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women
Milrad, S. F., Hall, D. L., Jutagir, D. R., Lattie, E. G., Ironson, G. H., Wohlgemuth, W. K., Vera-Nunez, M. A., Garcia, L., Czaja, S. J., Perdomo, D. M., et al. (2016) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2016.12.008 · Cited by 89 · see citing works
Inflammatory proteins are altered in chronic fatigue syndrome—A systematic review and meta-analysis
Strawbridge, R., Sartor, M.-L., Scott, F., & Cleare, A. J. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.08.011 · Cited by 79 · see citing works
Self-citation
A role for homeostatic drive in the perpetuation of complex chronic illness: gulf War illness and chronic fatigue syndrome
Craddock, T. J. A., Fritsch, P., Rice, M. A., del Rosario, R. M., Miller, D. B., Fletcher, M. A., Klimas, N. G., & Broderick, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0084839 · Cited by 75 · see citing works
Multiple Immune-Inflammatory and Oxidative and Nitrosative Stress Pathways Explain the Frequent Presence of Depression in Multiple Sclerosis
Morris, G., Reiche, E. M. V., Murru, A., Carvalho, A. F., Maes, M. H. J., Berk, M., & Puri, B. K. (2018) · Molecular Neurobiology · doi:10.1007/s12035-017-0843-5 · Cited by 74 · see citing works
A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior
Morris, G., Anderson, G., Gałecki, P., Berk, M., & Maes, M. H. J. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-64 · Cited by 74 · see citing works
Disease Mechanisms and Clonidine Treatment in Adolescent Chronic Fatigue Syndrome
Sulheim, D., Fagermoen, E., Winger, A., Andersen, A. M., Godang, K., Müller, F., Rowe, P. C., Saul, J. P., Skovlund, E., Øie, M. G., et al. (2014) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.4647 · Cited by 74 · see citing works
Predictors of chronic fatigue in adolescents six months after acute Epstein-Barr virus infection: A prospective cohort study
Pedersen, M., Asprusten, T. T., Godang, K., Leegaard, T. M., Osnes, L., Skovlund, E., Tjade, T., Øie, M. G., & Wyller, V. B. (2018) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2018.09.023 · Cited by 73 · see citing works
Epigenetic modifications and glucocorticoid sensitivity in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
de Vega, W. C., Herrera, S., Vernon, S. D., & McGowan, P. O. (2017) · BMC Medical Genomics · doi:10.1186/s12920-017-0248-3 · Cited by 73 · see citing works
Cortisol Response to Experimental Pain in Patients with Chronic Low Back Pain and Patients with Major Depression
Muhtz, C., Rodriguez‐Raecke, R., Hinkelmann, K., Moeller‐Bertram, T., Kiefer, F., Wiedemann, K., May, A., & Otte, C. (2012) · Pain Medicine · doi:10.1111/j.1526-4637.2012.01514.x · Cited by 71 · see citing works
Innovations in biological assessments of chronic stress through hair and nail cortisol: Conceptual, developmental, and methodological issues
Liu, C. H., & Doan, S. N. (2019) · Developmental Psychobiology · doi:10.1002/dev.21830 · Cited by 71 · see citing works
A review of the predisposing, precipitating and perpetuating factors in Chronic Fatigue Syndrome in children and adolescents.
Lievesley, K., Rimes, K., & Chalder, T. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.02.002 · Cited by 73 · see citing works
Mechanisms of glucocorticoid action and insensitivity in airways disease
Boardman, C., Chachi, L., Gavrila, A., Keenan, C. R., Perry, M. M., Xia, Y., Meurs, H., & Sharma, P. K. (2014) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2014.08.008 · Cited by 66 · see citing works
Chronic Fatigue Syndrome
Chalder, T. (2013) · doi:10.1002/9781118528563.wbcbt23 · Cited by 63 · see citing works
Myalgia and chronic fatigue syndrome following immunization: macrophagic myofasciitis and animal studies support linkage to aluminum adjuvant persistency and diffusion in the immune system
Gherardi, R. K., Crépeaux, G., & Authier, F. (2019) · Autoimmunity Reviews · doi:10.1016/j.autrev.2019.05.006 · Cited by 61 · see citing works
Whole blood gene expression in adolescent chronic fatigue syndrome: an exploratory cross-sectional study suggesting altered B cell differentiation and survival
Nguyen, C. B., Alsøe, L., Lindvall, J. M., Sulheim, D., Fagermoen, E., Winger, A., Kaarbø, M., Nilsen, H., & Wyller, V. B. (2017) · Journal of Translational Medicine · doi:10.1186/s12967-017-1201-0 · Cited by 59 · see citing works
Fibromyalgia and Chronic Fatigue: The Underlying Biology and Related Theoretical Issues
Romano, G. F., Tomassi, S., Russell, A., Mondelli, V., & Pariante, C. M. (2015) · Advances in psychosomatic medicine · doi:10.1159/000369085 · Cited by 59 · see citing works
Chronic-Stress-Induced Behavioral Changes Associated with Subregion-Selective Serotonin Cell Death in the Dorsal Raphe
Natarajan, R., Forrester, L., Chiaia, N. L., & Yamamoto, B. K. (2017) · Journal of Neuroscience · doi:10.1523/jneurosci.3781-16.2017 · Cited by 53 · see citing works
Metabolic mechanism of a polysaccharide from Schisandra chinensis to relieve chronic fatigue syndrome
Chi, A., Zhang, Y., Kang, Y., & Shen, Z. (2016) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2016.08.042 · Cited by 52 · see citing works
The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups
Twisk, F. (2014) · Frontiers in Physiology · doi:10.3389/fphys.2014.00109 · Cited by 51 · see citing works
Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation
Burfeind, K. G., Yadav, V., & Marks, D. L. (2016) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-016-0700-3 · Cited by 51 · see citing works
The Toll-Like Receptor Radical Cycle Pathway: A New Drug Target in Immune-Related Chronic Fatigue
Lucas, K., Morris, G., Anderson, G., & Maes, M. H. J. (2015) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527314666150317224645 · Cited by 50 · see citing works
Circadian cortisol and fatigue severity in relapsing-remitting multiple sclerosis
Powell, D., Moss-Morris, R. E., Liossi, C., & Schlotz, W. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.03.010 · Cited by 49 · see citing works
The prevalence and impact of early childhood trauma in Chronic Fatigue Syndrome
Kempke, S., Luyten, P., Claes, S. J., Wambeke, P. V., Bekaert, P., Goossens, L., & Houdenhove, B. V. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.01.021 · Cited by 51 · see citing works
Changes in fatigue, autonomic functions, and blood biomarkers due to sitting isometric yoga in patients with chronic fatigue syndrome
Oka, T., Tanahashi, T., Sudo, N., Lkhagvasuren, B., & Yamada, Y. (2018) · BioPsychoSocial Medicine · doi:10.1186/s13030-018-0123-2 · Cited by 47 · see citing works
Aberrant Resting-State Functional Connectivity in the Salience Network of Adolescent Chronic Fatigue Syndrome
Wortinger, L. A., Endestad, T., Melinder, A. M. D., Øie, M. G., Nilsen, A. S., & Wyller, V. B. (2016) · PLoS ONE · doi:10.1371/journal.pone.0159351 · Cited by 47 · see citing works
Anti-stress Effects of 20(S)-Protopanaxadiol and 20(S)-Protopanaxatriol in Immobilized Mice
Oh, H. A., Kim, D.-E., Choi, H. J., Kim, N. J., & Kim, D. (2015) · Biological and Pharmaceutical Bulletin · doi:10.1248/bpb.b14-00669 · Cited by 45 · see citing works
Clinical symptoms and markers of disease mechanisms in adolescent chronic fatigue following Epstein-Barr virus infection: An exploratory cross-sectional study
Kristiansen, M. S., Stabursvik, J., O'Leary, E. C., Pedersen, M., Asprusten, T. T., Leegaard, T. M., Osnes, L., Tjade, T., Skovlund, E., Godang, K., et al. (2019) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2019.04.040 · Cited by 46 · see citing works
Chronic Fatigue Syndrome and DNA Hypomethylation of the Glucocorticoid Receptor Gene Promoter 1F Region
Vangeel, E. B., Eede, F. V. D., Hompes, T., Izzi, B., Del‐Favero, J., Moorkens, G. H., Lambrechts, D., Freson, K., & Claes, S. J. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000224 · Cited by 44 · see citing works
Effects of early childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome.
Kempke, S., Luyten, P., Coninck, S. D., van Houdenhove, B., Mayes, L., & Claes, S. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.10.027 · Cited by 44 · see citing works
Learning to feel tired: A learning trajectory towards chronic fatigue
Lenaert, B., Boddez, Y., Vlaeyen, J. W. S., & Heugten, C. M. V. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.11.004 · Cited by 44 · see citing works
A Multi-Center Study Investigating Long COVID-19 in Healthcare Workers from North-Eastern Italy: Prevalence, Risk Factors and the Impact of Pre-Existing Humoral Immunity—ORCHESTRA Project
Cegolon, L., Mauro, M., Sansone, D., Tassinari, A., Gobba, F., Modenese, A., Casolari, L., Liviero, F., Pavanello, S., Scapellato, M. L., et al. (2023) · Vaccines · doi:10.3390/vaccines11121769 · Cited by 43 · see citing works
Increased risk of chronic fatigue syndrome following herpes zoster: a population-based study
Tsai, S., Yang, T.-Y., Chen, H.-Y., Chen, C.-S., Lin, W.-M., Shen, W., Kuo, C.-N., & Kao, C. (2014) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-014-2095-x · Cited by 41 · see citing works
Altered neuroendocrine control and association to clinical symptoms in adolescent chronic fatigue syndrome: a cross-sectional study
Wyller, V. B., Vitelli, V., Sulheim, D., Fagermoen, E., Winger, A., Godang, K., & Bollerslev, J. (2016) · Journal of Translational Medicine · doi:10.1186/s12967-016-0873-1 · Cited by 40 · see citing works
Short‐term and long‐term measures of cortisol in saliva and hair in atypical and non‐atypical depression
Herane-Vives, A., de Angel, V., Papadopoulos, A. S., Wise, T., Chua, K., Strawbridge, R., Castillo, D., Arnone, D., Young, A. H., & Cleare, A. J. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12852 · Cited by 41 · see citing works
Self-citation
Lowered oxygen saturation and increased body temperature in acute COVID-19 largely predict chronic fatigue syndrome and affective symptoms due to Long COVID: A precision nomothetic approach
Al-Hadrawi, D. S., Al-Rubaye, H. T., Almulla, A. F., Al‐Hakeim, H. K., & Maes, M. H. J. (2022) · Acta Neuropsychiatrica · doi:10.1017/neu.2022.21 · Cited by 37 · see citing works
Cortisol levels in chronic fatigue syndrome and atypical depression measured using hair and saliva specimens
Herane-Vives, A., Papadopoulos, A. S., de Angel, V., Chua, K., Soto, L., Chalder, T., Young, A. H., & Cleare, A. J. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.146 · Cited by 37 · see citing works
Self-citation
The traditional drug Gongjin-Dan ameliorates chronic fatigue in a forced-stress mouse exercise model
Hong, S.-S., Lee, J., Lee, J., Lee, H.-W., Kim, H.-G., Lee, S.-K., Park, B., & Son, C. (2015) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2015.04.001 · Cited by 37 · see citing works
Determination of 19 steroid hormones in human serum and urine using liquid chromatography-tandem mass spectrometry
Li, Z.-M., & Kannan, K. (2022) · Toxics · doi:10.3390/toxics10110687 · Cited by 37 · see citing works
The neuro-immune axis in cancer: from mechanisms to therapeutic opportunities
Zhang, C., Guo, X., Liu, P., Wang, Y., Zhang, J., Li, L., Wu, K., Xiao, J., Mei, Q., & Wang, Z. (2025) · Journal of Hematology & Oncology · doi:10.1186/s13045-025-01748-5 · Cited by 42 · see citing works
Chronic fatigue syndrome: the current status and future potentials of emerging biomarkers
Fischer, D. B., William, A., Strauss, A. C., Unger, E. R., Jason, L. A., Marshall, G. D., & Dimitrakoff, J. D. (2014) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2014.906066 · Cited by 36 · see citing works
Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome
Roerink, M. E., Roerink, S. H. P. P., Skoluda, N., van der Schaaf, M. E., Hermus, A. R., van der Meer, J. W. M., Knoop, H., & Nater, U. M. (2018) · Hormones and Behavior · doi:10.1016/j.yhbeh.2018.05.016 · Cited by 36 · see citing works
Myelophil attenuates brain oxidative damage by modulating the hypothalamus-pituitary-adrenal (HPA) axis in a chronic cold-stress mouse model
Kim, H.-G., Lee, J.-S., Han, J., Lee, J.-S., Choi, M., Son, S., Kim, Y.-K., & Son, C. (2013) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2013.04.046 · Cited by 34 · see citing works
Glucocorticoid receptor DNA methylation and childhood trauma in chronic fatigue syndrome patients
Vangeel, E. B., Kempke, S., Bakusic, J., Godderis, L., Luyten, P., Heddegem, L. V., Compernolle, V., Persoons, P., Lambrechts, D., Izzi, B., et al. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.11.011 · Cited by 32 · see citing works
Emotional suppression in chronic fatigue syndrome: Experimental study.
Rimes, K. A., Ashcroft, J., Bryan, L., & Chalder, T. (2016) · Health Psychology · doi:10.1037/hea0000341 · Cited by 31 · see citing works
Systematic review of mind‐body interventions to treat myalgic encephalomyelitis/chronic fatigue syndrome
Khanpour Ardestani, S., Karkhaneh, M., Stein, E., Punja, S., Junqueira, D. R., Kuzmyn, T., Pearson, M., Smith, L., Olson, K., & Vohra, S. (2021) · Medicina · doi:10.3390/medicina57070652 · Cited by 30 · see citing works
“Other studies highlight changes in the hypothalamic‐pituitary‐adrenal (HPA) axis in these patients [104].”
Background
Dysregulated stress signal sensitivity and inflammatory disinhibition as a pathophysiological mechanism of stress-related chronic fatigue
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The Neuroendocrinology of Chronic Fatigue Syndrome
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A Review of Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome
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Authors: Papadopoulos, A. S., & Cleare, A. J.
Corresponding author: Cleare, Anthony J.
ORCID: Papadopoulos, Andrew S.
Cleare, Anthony J.
Venue: Nature Reviews Endocrinology
Publisher: Springer Science and Business Media LLC
Published: 2011-09-27
Volume: 8
Issue: 1
Pages: 22-32
ISSN: 1759-5029 (ISSN-L)
1759-5037
DOI: 10.1038/nrendo.2011.153
OpenAlex: W2010485769
Cited by: 280
References: 92
Citations by year: 2026: 18 · 2025: 18 · 2024: 23 · 2023: 13 · 2022: 14 · 2021: 15 · 2020: 15 · 2019: 17 · 2018: 20 · 2017: 26 · 2016: 24 · 2015: 26 · 2014: 22 · 2013: 21 · 2012: 8
FWCI: 2.14
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Nature Reviews Endocrinology (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords: chronic fatigue syndrome, hypothalamic-pituitary-adrenal axis, cortisol, adrenal insufficiency, diurnal cortisol rhythm, depression, early life stress, psychotropic drugs, cognitive behavioral therapy, steroid replacement therapy, disability
MeSH terms: Dehydroepiandrosterone, Humans, Hydrocortisone, Hypothalamic Diseases, Hypothalamo-Hypophyseal System, Models, Biological, Pituitary-Adrenal System, Meta-Analysis as Topic, Fatigue Syndrome, Chronic

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Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome

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