Jerjes, Walid K, Peters, Timothy J, Taylor, Norman F et al. · Journal of psychosomatic research · 2006 · DOI
This study measured stress hormone levels in urine samples from ME/CFS patients and healthy people throughout the day. Researchers found that ME/CFS patients had lower levels of certain stress hormones (cortisol and cortisone) compared to healthy controls, though the daily pattern of these hormones was normal. Interestingly, when they looked at other related hormone measurements, they didn't see the same difference, which suggests the stress response system may not be working as hard in ME/CFS.
Understanding the hormonal basis of ME/CFS is crucial for developing targeted treatments and validating the biological nature of the disease. This study provides objective evidence of altered stress hormone physiology in carefully characterized patients, helping establish that ME/CFS involves measurable biological changes rather than being primarily psychological. These findings could guide future research into whether restoring normal HPA function might improve symptoms.
This study does not establish whether low cortisol causes ME/CFS symptoms or results from the illness. The conflicting results between free cortisol and metabolite measures mean the authors cannot definitively conclude the exact nature of HPA axis dysfunction. The cross-sectional design cannot determine causality, and the findings apply only to unmedicated patients without psychiatric comorbidities, limiting generalizability.
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, Walid K, Peters, Timothy J, Taylor, Norman F, Wood, Peter J, Wessely, Simon, & Cleare, Anthony J (2006). Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2005.07.008
BibTeX
@article{mecfsatlas-jerjes-2006-diurnal-excretion,
author = {Jerjes, Walid K and Peters, Timothy J and Taylor, Norman F and Wood, Peter J and Wessely, Simon and Cleare, Anthony J},
title = {Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2006},
doi = {10.1016/j.jpsychores.2005.07.008},
note = {PubMed: 16439267},
url = {https://www.mecfsatlas.com/evidence/jerjes-2006-diurnal-excretion},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/jerjes-2006-diurnal-excretion
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