Powell, Daniel J H, Liossi, Christina, Moss-Morris, Rona et al. · Psychoneuroendocrinology · 2013 · DOI
This review looked at whether cortisol levels (a stress hormone) measured in saliva throughout the day are different in people with ME/CFS compared to healthy controls. Researchers found that people with ME/CFS showed a slightly smaller increase in cortisol when they first wake up, compared to healthy people. However, total cortisol levels during the day were not consistently related to how fatigued people felt.
Understanding how the stress hormone system functions in ME/CFS could help explain why patients experience persistent fatigue and may guide development of targeted treatments. This review synthesizes evidence about a key biological system and identifies which cortisol measurements are most relevant to fatigue, directing future research priorities.
This study does not prove that abnormal cortisol patterns cause ME/CFS or fatigue—only that associations exist. The findings are correlational and modest in effect size; the small number of studies and heterogeneity in methods mean conclusions should be considered preliminary. This review cannot establish whether correcting cortisol patterns would improve fatigue.
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
Powell, Daniel J H, Liossi, Christina, Moss-Morris, Rona, & Schlotz, Wolff (2013). Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis.. Psychoneuroendocrinology. https://doi.org/10.1016/j.psyneuen.2013.07.004
BibTeX
@article{mecfsatlas-powell-2013-unstimulated-cortisol,
author = {Powell, Daniel J H and Liossi, Christina and Moss-Morris, Rona and Schlotz, Wolff},
title = {Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis.},
journal = {Psychoneuroendocrinology},
year = {2013},
doi = {10.1016/j.psyneuen.2013.07.004},
note = {PubMed: 23916911},
url = {https://www.mecfsatlas.com/evidence/powell-2013-unstimulated-cortisol},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/powell-2013-unstimulated-cortisol
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