Heim, C, Ehlert, U, Hellhammer, D H · Psychoneuroendocrinology · 2000 · DOI
This review examines why some people under chronic stress or after trauma have abnormally low levels of the stress hormone cortisol—a condition called hypocortisolism. The authors found that low cortisol appears in several conditions including ME/CFS, fibromyalgia, and rheumatoid arthritis, not just in PTSD. They propose that persistently low cortisol may make people more vulnerable to developing stress-related illnesses.
For ME/CFS patients, this review is significant because it identifies hypocortisolism as a potential shared neuroendocrine mechanism in ME/CFS alongside other chronic conditions, suggesting a common pathway to illness rather than isolated pathology. Understanding that low cortisol may increase vulnerability to developing or maintaining ME/CFS could inform future treatment approaches and help explain why some patients experience worsening with stress.
This review does not prove that low cortisol causes ME/CFS or other listed conditions—it documents an association across multiple disorders. The study cannot establish whether hypocortisolism is a primary cause, a consequence of chronic illness, or a secondary adaptation to prolonged stress. It also does not determine whether the HPA axis dysfunction mechanisms are identical across different patient populations.
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
Heim, C, Ehlert, U, & Hellhammer, D H (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders.. Psychoneuroendocrinology. https://doi.org/10.1016/s0306-4530(99)00035-9
BibTeX
@article{mecfsatlas-heim-2000-potential-role,
author = {Heim, C and Ehlert, U and Hellhammer, D H},
title = {The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders.},
journal = {Psychoneuroendocrinology},
year = {2000},
doi = {10.1016/s0306-4530(99)00035-9},
note = {PubMed: 10633533},
url = {https://www.mecfsatlas.com/evidence/heim-2000-potential-role},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/heim-2000-potential-role
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