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Cortisol
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==ME/CFS== === Findings === Hypocortisolism (a low cortisol level) frequently occurs in patients with [[ME/CFS]], confirmed by studies measuring cortisol levels and in urine<ref name="Scott, 1998" /> and saliva.<ref name="Schmaling, 2015" /><ref name="Nijhof, 2014" /> In addition to general hypocortisolism, [[ME/CFS]] patients have a decreased cortisol awakening response, ie, morning cortisol levels peak later compared to healthy controls.<ref name="Roerink, 2018" /> In 2018, Roerink, et al, studied hair cortisol concentrations in [[Chronic fatigue syndrome|CFS]] patients to assess if hypocortisolism was a prolonged phenomenon. They found that there was a trend of lower hair cortisol concentrations in [[Chronic fatigue syndrome|CFS]] patients, thus suggesting that hypocortisolism was long-term in [[ME/CFS]].<ref name="Roerink, 2018" /> As people with [[ME/CFS]] improved, their hypocortisolism improved.<ref name="Nijhof, 2014" /> === Clinical trials === A 1998 double-blind, randomized, placebo-controlled trial found that low dose hydrocortisone led to a statistical improvement in one subjective score, the Wellness scale. No statistical evidence of improvement was seen with the other self-rating scales. The authors concluded that: although hydrocortisone treatment was associated with some improvement in symptoms of CFS, the degree of adrenal suppression precludes its practical use for CFS.<ref>{{Cite journal | last = McKenzie | first = R | date = Sep 1998 | title = Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial | url = https://www.ncbi.nlm.nih.gov/pubmed/9757853|journal=JAMA|volume=280 | issue = 12 | pages = 1061-6|via=}}</ref> In 1999, the Institute of Psychiatry, London, did a randomized crossover trial, in which [[Simon Wessely]] was an author, where low dose hydrocortisone treatments given to patients with [[chronic fatigue syndrome]] were found to reduce [[fatigue]] scores and that 28% of patients in the treatment group had reductions in scores that brought them to or close to normal in the short term.<ref>{{Cite journal | last = Cleare | first = AJ | date = February 1999 | title = Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial | url = https://www.ncbi.nlm.nih.gov/pubmed/9989716|journal=Lancet|volume=353 | pages = 455-8|via=}}</ref> A 2003 double-blind, randomized, placebo-controlled trial of hydrocortisone in combination with [[fludrocortisone]] found no difference in self-reported outcomes from when patients received the placebo vs. the medication.<ref>{{Cite journal | last = Blockmans | first = D | date = Jun 2003 | title = Combination therapy with hydrocortisone and fludrocortisone does not improve symptoms in chronic fatigue syndrome: a randomized, placebo-controlled, double-blind, crossover study | url = https://www.ncbi.nlm.nih.gov/pubmed/12829200|journal=Am J Med|volume=114 | issue = 9 | pages = 736-41|via=}}</ref>
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