From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Cortisol is a steroid hormone released by the adrenal glands which sit upon the kidneys. It is the main stress hormone in the human body.[1] Release of cortisol is controlled by the hypothalamus, a part of the brain.[1]

Cortisol has several known roles in the human body: aiding in metabolism, reducing inflammation, assisting electrolyte balance, stimulating gastric-acid secretion and controlling one's sleep/wake cycle.[2][1] Cortisol given as a medicine is known as hydrocortisone.

Normal blood level of cortisol vary throughout the day, with the highest level in the morning upon awakening and lowest level around midnight. Levels can also rise in reaction to stress or low blood sugar. Some health conditions can cause an increase in cortisol, such as depression[3] and Cushing syndrome.[1] Other health conditions can cause a decrease, such as Addison's disease[4] and ME/CFS.[5]

ME/CFS[edit | edit source]

Findings[edit | edit source]

Hypocortisolism (a low cortisol level) frequently occurs in patients with ME/CFS, confirmed by studies measuring cortisol levels and in urine[3] and saliva.[6][7] In addition to general hypocortisolism, ME/CFS patients have a decreased cortisol awakening response, ie, morning cortisol levels peak later compared to healthy controls.[8] In 2018, Roerink, et al, studied hair cortisol concentrations in CFS patients to assess if hypocortisolism was a prolonged phenomenon. They found that there was a trend of lower hair cortisol concentrations in CFS patients, thus suggesting that hypocortisolism was long-term in ME/CFS.[8] As people with ME/CFS improved, their hypocortisolism improved.[7]

Clinical trials[edit | edit source]

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.[9]

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.[10]

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.[11]

Notable studies[edit | edit source]

  • 1998, Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers[3] (Abstract)
  • 2000, Review article - Chronic Fatigue Syndrome: A Dysfunction of the Hypothalamic-Pituitary-Adrenal Axis[12] (Abstract)
  • 2014, The role of hypocortisolism in chronic fatigue syndrome[7] (Abstract)
  • 2015, Salivary cortisol responses to household tasks among couples with unexplained chronic fatigue[6] (Full Text)
  • 2018, Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome[8] (Abstract)
  • 2018, A State-Space Investigation of Cortisol Alterations in Chronic Fatigue Syndrome[13]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 "What Is Cortisol?". WebMD. Retrieved February 16, 2021.
  2. "Cortisol". Hormone Health Network. Retrieved February 16, 2021.
  3. 3.0 3.1 3.2 Scott, LV; Dinan, TG (1998), "Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers", J Affect Disord, 47 (1–3): 49-54, PMID 9476743
  4. "Primary Adrenal Insufficiency (Addison's Disease)". National Adrenal Diseases Foundation. Retrieved February 16, 2021.
  5. Addington, John W. (January 1, 2000). "Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 7 (2): 63–74. doi:10.1300/J092v07n02_06. ISSN 1057-3321.
  6. 6.0 6.1 Schmaling, K.B.; Romano, J.M.; Jensen, M.P.; Wilkinson, C.W.; McPherson, S. (2015), "Salivary Cortisol Responses to Household Tasks among Couples with Unexplained Chronic Fatigue", Journal of Family Psychology : JFP : Journal of the Division of Family Psychology of the American Psychological Association (Division 43), 29 (2): 296–301, doi:10.1037/fam0000074
  7. 7.0 7.1 7.2 Nijhof, SL; Rutten, JM; Uiterwaal, CS; Bleijenberg, G; Kimpen, JL; Putte, EM (2014), "The role of hypocortisolism in chronic fatigue syndrome", Psychoneuroendocrinology, 42: 199-206, doi:10.1016/j.psyneuen.2014.01.017
  8. 8.0 8.1 8.2 Roerink, Megan E.; Roerink, Sean H.P.P.; Skoluda, Nadine; van der Schaaf, Marieke E.; Hermus, Ad R.M.M.; van der Meer, Jos W.M.; Knoop, Hans; Nater, Urs M. (2018), "Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome", Hormones and Behavior, 103: 1–6, doi:10.1016/j.yhbeh.2018.05.016
  9. McKenzie, R (September 1998). "Low-dose hydrocortisone for treatment of chronic fatigue syndrome: a randomized controlled trial". JAMA. 280 (12): 1061–6.
  10. Cleare, AJ (February 1999). "Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial". Lancet. 353: 455–8.
  11. Blockmans, D (June 2003). "Combination therapy with hydrocortisone and fludrocortisone does not improve symptoms in chronic fatigue syndrome: a randomized, placebo-controlled, double-blind, crossover study". Am J Med. 114 (9): 736–41.
  12. Addington, John W. (2000), "Chronic Fatigue Syndrome: A Dysfunction of the Hypothalamic-Pituitary-Adrenal Axis", Journal of Chronic Fatigue Syndrome, 7 (2): 63-74, doi:10.1300/J092v07n02_06
  13. Hua, Huy; Amin, Rafiul; Wickramasuriya, Dilranjan S.; Faghih, Rose T. (2018). "A State-Space Investigation of Cortisol Alterations in Chronic Fatigue Syndrome". Undergraduate Research Day Summer Undergraduate Research Fellowship (SURF) Projects - University of Houston.