Morris, Gerwyn, Anderson, George, Maes, Michael · Molecular neurobiology · 2017 · DOI
This review examines why people with ME/CFS often have low cortisol levels (a stress hormone). The researchers found that the problem likely starts with an overactive immune system producing excessive inflammatory markers, which then damages the body's stress-hormone system. This is important because it suggests the low cortisol is a consequence of the disease, not its cause.
Understanding whether HPA axis dysfunction causes or results from immune activation has critical implications for treatment strategies. If immune activation drives HPA suppression, therapeutic approaches should target immune pathways rather than attempting hormone replacement. This reframing could redirect research and clinical practice toward more mechanistically appropriate interventions.
This review does not establish definitive causal mechanisms—it interprets correlational data from multiple studies. It does not prove that immune pathways are the sole cause of HPA dysfunction, nor does it demonstrate whether these pathways are primary disease drivers or secondary amplifiers. Individual patient heterogeneity may mean different subgroups have different underlying mechanisms.
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 →
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Primary citation
Morris, Gerwyn, Anderson, George, & Maes, Michael (2017). Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways.. Molecular neurobiology. https://doi.org/10.1007/s12035-016-0170-2
BibTeX
@article{mecfsatlas-morris-2017-hypothalamic-pituitary,
author = {Morris, Gerwyn and Anderson, George and Maes, Michael},
title = {Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways.},
journal = {Molecular neurobiology},
year = {2017},
doi = {10.1007/s12035-016-0170-2},
note = {PubMed: 27766535},
url = {https://www.mecfsatlas.com/evidence/morris-2017-hypothalamic-pituitary},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/morris-2017-hypothalamic-pituitary
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