López-Amador, Noé · Family practice · 2023 · DOI
This case report describes one patient with ME/CFS who had abnormal hormone levels (low thyroid and adrenal hormones, but high cortisol) and brain imaging showing shrinkage of the brain's outer layer. When treated with a low dose of a medication called modafinil along with lifestyle changes, the patient's symptoms improved. The study highlights that ME/CFS can have measurable physical changes and that doctors need better tools to diagnose and treat this condition.
This case provides rare objective evidence linking ME/CFS to measurable biological abnormalities—specifically neuroendocrine dysregulation and structural brain changes—which strengthens the argument that ME/CFS is an organic disease. Documenting treatment response offers clinical insights for practitioners managing similar patients, and the study underscores the need for systematic diagnostic protocols in primary care.
As a single case report, this study does not prove that all ME/CFS patients have cortical atrophy, abnormal cortisol levels, or will respond to modafinil. The findings may not be representative of the broader ME/CFS population, and the improvement observed could be due to natural fluctuation, placebo effect, nonpharmacologic interventions, or a combination of factors rather than modafinil alone. Causality between these biological findings and disease pathophysiology cannot be established from one case.
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
López-Amador, Noé (2023). Systemic exertion intolerance disease associated to neuroendocrine dysfunction and cortical atrophy: a case report.. Family practice. https://doi.org/10.1093/fampra/cmac060
BibTeX
@article{mecfsatlas-lpez-amador-2023-systemic-exertion,
author = {López-Amador, Noé},
title = {Systemic exertion intolerance disease associated to neuroendocrine dysfunction and cortical atrophy: a case report.},
journal = {Family practice},
year = {2023},
doi = {10.1093/fampra/cmac060},
note = {PubMed: 35640045},
url = {https://www.mecfsatlas.com/evidence/lpez-amador-2023-systemic-exertion},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/lpez-amador-2023-systemic-exertion
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