Nater, Urs M, Youngblood, Laura Solomon, Jones, James F et al. · Psychosomatic medicine · 2008 · DOI
This study measured stress hormone (cortisol) levels and immune markers in saliva and blood from people with ME/CFS, people with significant fatigue who don't meet full CFS criteria, and healthy controls. People with ME/CFS showed an abnormal pattern: lower cortisol in the morning and higher in the evening (the opposite of what's healthy), suggesting their stress-response system may not be working normally.
This study provides evidence that ME/CFS involves measurable dysfunction in the body's stress-response system (HPA axis), which could help explain persistent fatigue and may guide development of targeted treatments. Understanding these biological abnormalities legitimizes ME/CFS as a physiological condition rather than a purely psychological one.
This cross-sectional study cannot establish causation—abnormal cortisol patterns may be a consequence of ME/CFS rather than its cause. The study does not prove that HPA axis dysfunction is the primary mechanism of ME/CFS, only that it is associated with the condition. Results are correlational and do not establish whether correcting cortisol rhythm would improve symptoms.
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
Nater, Urs M, Youngblood, Laura Solomon, Jones, James F, Unger, Elizabeth R, Miller, Andrew H, Reeves, William C, et al. (2008). Alterations in diurnal salivary cortisol rhythm in a population-based sample of cases with chronic fatigue syndrome.. Psychosomatic medicine. https://doi.org/10.1097/PSY.0b013e3181651025
BibTeX
@article{mecfsatlas-nater-2008-alterations-diurnal,
author = {Nater, Urs M and Youngblood, Laura Solomon and Jones, James F and Unger, Elizabeth R and Miller, Andrew H and Reeves, William C and Heim, Christine},
title = {Alterations in diurnal salivary cortisol rhythm in a population-based sample of cases with chronic fatigue syndrome.},
journal = {Psychosomatic medicine},
year = {2008},
doi = {10.1097/PSY.0b013e3181651025},
note = {PubMed: 18378875},
url = {https://www.mecfsatlas.com/evidence/nater-2008-alterations-diurnal},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/nater-2008-alterations-diurnal
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