Nater, Urs M, Maloney, Elizabeth, Boneva, Roumiana S et al. · The Journal of clinical endocrinology and metabolism · 2008 · DOI
This study looked at cortisol, a hormone released by the body in the morning to help us wake up and manage stress. Researchers compared cortisol levels in people with ME/CFS to healthy people and found that ME/CFS patients, especially women, had lower morning cortisol levels than expected. This suggests the hormone system that controls cortisol may not be working normally in ME/CFS.
HPA axis dysfunction is a proposed biological mechanism in ME/CFS, and identifying measurable biomarkers like attenuated cortisol could help with diagnosis and understanding disease pathophysiology. The finding of sex-specific differences suggests that men and women with ME/CFS may have distinct biological profiles, potentially explaining why women are diagnosed more frequently and may help guide personalized treatment approaches.
This study does not prove that low cortisol causes ME/CFS—it shows an association only. The cross-sectional design cannot establish whether cortisol dysregulation precedes CFS onset or develops as a consequence of illness. The findings also cannot explain the mechanisms underlying the sex difference or determine whether cortisol abnormalities are universal across all ME/CFS patients.
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, Maloney, Elizabeth, Boneva, Roumiana S, Gurbaxani, Brian M, Lin, Jin-Mann, Jones, James F, et al. (2008). Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls.. The Journal of clinical endocrinology and metabolism. https://doi.org/10.1210/jc.2007-1747
BibTeX
@article{mecfsatlas-nater-2008-attenuated-morning,
author = {Nater, Urs M and Maloney, Elizabeth and Boneva, Roumiana S and Gurbaxani, Brian M and Lin, Jin-Mann and Jones, James F and Reeves, William C and Heim, Christine},
title = {Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls.},
journal = {The Journal of clinical endocrinology and metabolism},
year = {2008},
doi = {10.1210/jc.2007-1747},
note = {PubMed: 18160468},
url = {https://www.mecfsatlas.com/evidence/nater-2008-attenuated-morning},
}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-attenuated-morning
Contribute
Private, reviewed by a human. Not a public comment thread.