Rimes, Katharine A, Papadopoulos, Andrew S, Cleare, Anthony J et al. · Journal of psychosomatic research · 2014 · DOI
This study measured stress hormone (cortisol) levels in teenagers with ME/CFS compared to healthy teenagers. Teenagers with ME/CFS had lower cortisol levels throughout the day than healthy peers. After cognitive behavioural treatment, cortisol levels in the ME/CFS group returned to normal, suggesting the hormonal difference may be reversible.
This is one of the first studies to document and quantify hypothalamic-pituitary-adrenal (HPA) axis dysfunction in adolescents with ME/CFS, extending prior adult findings to a younger population. The finding that hormonal abnormalities reversed with cognitive behavioural treatment provides evidence that at least some physiological markers of ME/CFS may be modifiable, which has implications for understanding disease mechanisms and treatment potential.
This study does not prove that low cortisol causes ME/CFS or that it is the primary driver of fatigue symptoms. The association between perfectionism, prosocial behaviour, and low cortisol does not establish causation. The study cannot determine whether the cortisol increase after treatment reflects improvement in ME/CFS per se or is secondary to general recovery from other factors.
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
Rimes, Katharine A, Papadopoulos, Andrew S, Cleare, Anthony J, & Chalder, Trudie (2014). Cortisol output in adolescents with chronic fatigue syndrome: pilot study on the comparison with healthy adolescents and change after cognitive behavioural guided self-help treatment.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2014.08.018
BibTeX
@article{mecfsatlas-rimes-2014-cortisol-output,
author = {Rimes, Katharine A and Papadopoulos, Andrew S and Cleare, Anthony J and Chalder, Trudie},
title = {Cortisol output in adolescents with chronic fatigue syndrome: pilot study on the comparison with healthy adolescents and change after cognitive behavioural guided self-help treatment.},
journal = {Journal of psychosomatic research},
year = {2014},
doi = {10.1016/j.jpsychores.2014.08.018},
note = {PubMed: 25260861},
url = {https://www.mecfsatlas.com/evidence/rimes-2014-cortisol-output},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/rimes-2014-cortisol-output
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