Gur, Ali, Cevik, Remzi, Nas, Kemal et al. · Arthritis research & therapy · 2004 · DOI
This study examined hormone levels in women with fibromyalgia and ME/CFS, comparing them to healthy women. Researchers found that women with both conditions had lower cortisol (a stress hormone) than healthy controls, but other reproductive hormones were similar across groups. Depression symptoms appeared to be connected to even lower cortisol levels, though it's unclear whether depression causes low cortisol or low cortisol contributes to depression.
Understanding hormone dysregulation in ME/CFS—particularly cortisol abnormalities—could help explain fatigue, cognitive dysfunction, and mood symptoms. This work highlights potential links between neuroendocrine dysfunction and depression in ME/CFS, important for developing targeted treatments and distinguishing biological from psychological contributions to illness.
This study cannot establish whether low cortisol causes depression or vice versa, nor can it prove causation in any direction given its cross-sectional design. The findings are limited to women in the follicular phase and may not generalize to luteal-phase women or men. A single morning cortisol measurement does not assess the full 24-hour cortisol rhythm, which may be disrupted in ME/CFS.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Gur, Ali, Cevik, Remzi, Nas, Kemal, Colpan, Leyla, & Sarac, Serdar (2004). Cortisol and hypothalamic-pituitary-gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and effect of depressive symptoms on these hormones.. Arthritis research & therapy. https://doi.org/10.1186/ar1163
BibTeX
@article{mecfsatlas-gur-2004-cortisol-hypothalamic,
author = {Gur, Ali and Cevik, Remzi and Nas, Kemal and Colpan, Leyla and Sarac, Serdar},
title = {Cortisol and hypothalamic-pituitary-gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and effect of depressive symptoms on these hormones.},
journal = {Arthritis research & therapy},
year = {2004},
doi = {10.1186/ar1163},
note = {PubMed: 15142269},
url = {https://www.mecfsatlas.com/evidence/gur-2004-cortisol-hypothalamic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/gur-2004-cortisol-hypothalamic
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