Salivary cortisol response to awakening in chronic fatigue syndrome
Open accessAbstract
Background: There is accumulating evidence of hypothalamic–pituitary–adrenal (HPA) axis disturbances in chronic fatigue syndrome (CFS). The salivary cortisol response to awakening has been described recently as a non-invasive test of the capacity of the HPA axis to respond to stress. The results of this test correlate closely with those of more invasive dynamic tests reported in the literature; furthermore, it can be undertaken in a naturalistic setting. Aims: To assess the HPA axis using the salivary cortisol response to awakening in CFS. Method: We measured salivary cortisol upon awakening and 10, 20, 30 and 60 min afterwards in 56 patients with CFS and 35 healthy volunteers. Results: Patients had a lower cortisol response to awakening, measured by the area under the curve. Conclusions: This naturalistic test of the HPA axis response to stress showed impaired HPA axis function in CFS.
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Impairment in the HPA-axis has been suggested as one of the biological factors contributing to the maintenance of fatigue and other symptoms in CFS.
“Impairment in the HPA-axis has been suggested as one of the biological factors contributing to the maintenance in fatigue and other symptoms in CFS (16).”
From The role of insomnia in the treatment of chronic fatigue. (2015) · cites this paper as [16]
Subjects with chronic fatigue syndrome and post-traumatic stress disorder tend to show decreased cortisol awakening responses.
“In contrast, subjects with chronic fatigue syndrome (Roberts et al., 2004), and post-traumatic stress disorder (Rohleder et al., 2004; Wessa et al., 2006), conditions usually characterized by lower cortisol levels during the day (Cleare, 2003; Yehuda, 2001), also tend to show decreased cortisol awakening responses (Roberts et al., 2004).”
From Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: The role of stress and of antipsychotic treatment (2010) · cites this paper as Roberts et al., 2004
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- Authors
- Roberts, A. D. L., Wessely, S., Chalder, T., Papadopoulos, A., & Cleare, A. J.
- Affiliations
- King's College Hospital (GB)
- King's College London (GB)
- Maudsley Hospital (GB)
- Corresponding author
- Cleare, Anthony J.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2004-02
- Volume
- 184
- Issue
- 2
- Pages
- 136-141
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2003884440
- Semantic Scholar
- 2e80046f598e970cc897ec26e9d44904c3a82537
- Cited by
- 265
- References
- 35
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 9 · 2021: 1 · 2020: 7 · 2019: 10 · 2018: 8 · 2017: 8 · 2016: 16 · 2015: 20 · 2014: 16 · 2013: 20 · 2012: 16
- FWCI
- 8.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lincoln Repository (University of Lincoln) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion)
- Funders
- King's College London
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- chronic fatigue syndrome, salivary cortisol, cortisol awakening response, hypothalamic-pituitary-adrenal axis, HPA axis dysregulation, stress response
- MeSH terms
- Adolescent, Adult, Aged, Depressive Disorder, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal System, Saliva, Sex Factors, Sleep, Smoking, Time Factors, Fatigue Syndrome, Chronic
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