Di Giorgio, Annabella, Hudson, Marina, Jerjes, Walid et al. · Psychosomatic medicine · 2005 · DOI
Researchers measured hormone levels in ME/CFS patients and healthy people over a full 24-hour period to see if the body's stress-hormone system works differently. They found that ME/CFS patients had lower levels of ACTH (a hormone that signals the adrenal glands) throughout the day, especially in the morning when levels normally peak. Other hormones tested were normal, suggesting a subtle problem with how the stress-hormone system is regulated.
HPA axis dysfunction has been hypothesized as a key mechanism in ME/CFS pathophysiology. This detailed 24-hour hormonal profiling provides objective biological evidence of subtle dysregulation that could guide future research into therapeutic targets and help validate ME/CFS as a biological disorder with measurable neuroendocrine signatures.
This study does not prove that HPA axis abnormality causes ME/CFS or is primary to the illness—it may instead be a consequence of prolonged illness. The cross-sectional design cannot establish whether these ACTH changes precede illness onset or develop as a secondary adaptation. The small sample and lack of statistical power mean findings may not generalize to the broader ME/CFS population.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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Primary citation
Di Giorgio, Annabella, Hudson, Marina, Jerjes, Walid, & Cleare, Anthony J (2005). 24-hour pituitary and adrenal hormone profiles in chronic fatigue syndrome.. Psychosomatic medicine. https://doi.org/10.1097/01.psy.0000161206.55324.8a
BibTeX
@article{mecfsatlas-di-giorgio-2005-hour-pituitary,
author = {Di Giorgio, Annabella and Hudson, Marina and Jerjes, Walid and Cleare, Anthony J},
title = {24-hour pituitary and adrenal hormone profiles in chronic fatigue syndrome.},
journal = {Psychosomatic medicine},
year = {2005},
doi = {10.1097/01.psy.0000161206.55324.8a},
note = {PubMed: 15911907},
url = {https://www.mecfsatlas.com/evidence/di-giorgio-2005-hour-pituitary},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/di-giorgio-2005-hour-pituitary
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