Jerjes, W K, Cleare, A J, Wessely, S et al. · Journal of affective disorders · 2005 · DOI
This study measured stress hormone levels (cortisol and cortisone) in saliva samples from ME/CFS patients and healthy people throughout the day. Researchers found that ME/CFS patients had lower levels of both hormones compared to healthy controls, but the daily pattern of these hormones remained similar between the two groups. This suggests that the body's stress response system may not be working at full capacity in some ME/CFS patients.
Understanding HPA axis dysfunction in ME/CFS could explain symptoms like fatigue and help develop better treatments. This study was among the first to measure cortisone (not just cortisol) in ME/CFS patients, providing a more complete picture of how the body's stress hormone system is affected. These findings support the hypothesis that reduced baseline HPA function characterizes at least a subset of ME/CFS patients.
This study does not prove that HPA axis dysfunction causes ME/CFS symptoms or that cortisol abnormalities occur in all ME/CFS patients, as the sample was small and drawn from specialist referral populations with established long-term illness. The cross-sectional design prevents determination of whether HPA changes precede disease onset or result from chronic illness. The preserved circadian rhythm suggests the axis is not fundamentally broken, only running at lower output.
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
Jerjes, W K, Cleare, A J, Wessely, S, Wood, P J, & Taylor, N F (2005). Diurnal patterns of salivary cortisol and cortisone output in chronic fatigue syndrome.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2005.03.013
BibTeX
@article{mecfsatlas-jerjes-2005-diurnal-patterns,
author = {Jerjes, W K and Cleare, A J and Wessely, S and Wood, P J and Taylor, N F},
title = {Diurnal patterns of salivary cortisol and cortisone output in chronic fatigue syndrome.},
journal = {Journal of affective disorders},
year = {2005},
doi = {10.1016/j.jad.2005.03.013},
note = {PubMed: 15922454},
url = {https://www.mecfsatlas.com/evidence/jerjes-2005-diurnal-patterns},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/jerjes-2005-diurnal-patterns
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