Nijhof, Sanne L, Rutten, Juliette M T M, Uiterwaal, Cuno S P M et al. · Psychoneuroendocrinology · 2014 · DOI
This study looked at stress hormone levels (cortisol) in adolescents with ME/CFS by measuring saliva samples. Teenagers with ME/CFS had lower cortisol levels than healthy peers, and those who improved with treatment showed their cortisol levels normalize, while those who didn't recover showed little change. The findings suggest that restoration of normal cortisol production during treatment may be linked to better outcomes.
This is the first study examining HPA axis dysfunction in adolescent ME/CFS, expanding understanding beyond adults. The finding that cortisol normalization—rather than baseline levels—predicts treatment success may help identify which adolescents are likely to benefit from specific interventions and could inform personalized treatment strategies.
This study does not establish that low cortisol *causes* ME/CFS or that restoring cortisol is the mechanism of recovery; it only shows an association. The study also cannot determine whether cortisol changes are a primary driver of recovery or a marker of broader physiological normalization. Results are limited to adolescents and may not generalize to adults with ME/CFS.
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
Nijhof, Sanne L, Rutten, Juliette M T M, Uiterwaal, Cuno S P M, Bleijenberg, Gijs, Kimpen, Jan L L, & Putte, Elise M van de (2014). The role of hypocortisolism in chronic fatigue syndrome.. Psychoneuroendocrinology. https://doi.org/10.1016/j.psyneuen.2014.01.017
BibTeX
@article{mecfsatlas-nijhof-2014-role-hypocortisolism,
author = {Nijhof, Sanne L and Rutten, Juliette M T M and Uiterwaal, Cuno S P M and Bleijenberg, Gijs and Kimpen, Jan L L and Putte, Elise M van de},
title = {The role of hypocortisolism in chronic fatigue syndrome.},
journal = {Psychoneuroendocrinology},
year = {2014},
doi = {10.1016/j.psyneuen.2014.01.017},
note = {PubMed: 24636516},
url = {https://www.mecfsatlas.com/evidence/nijhof-2014-role-hypocortisolism},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/nijhof-2014-role-hypocortisolism
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