Roerink, Megan E, Roerink, Sean H P P, Skoluda, Nadine et al. · Hormones and behavior · 2018 · DOI
This study measured cortisol (a stress hormone) in hair and saliva samples from women with ME/CFS and compared them to healthy women. The ME/CFS patients showed lower cortisol levels, particularly a weaker morning cortisol rise. When some patients took a medication called anakinra (which reduces inflammation), their cortisol levels changed differently than in patients taking placebo, suggesting a link between the immune system and hormonal stress response in ME/CFS.
This research provides the first evidence that HPA axis dysfunction in ME/CFS extends to long-term cortisol measures (hair) and not just acute salivary markers. The finding that an immune-modulating drug alters cortisol patterns suggests HPA axis abnormalities may be linked to immune dysregulation, which could guide future treatment approaches targeting both systems.
This study does not prove that low cortisol causes ME/CFS symptoms or that anakinra is an effective treatment—it only shows associations and short-term hormonal changes. The small subset with hair cortisol data (46 per group) and lack of long-term outcome data limit conclusions about clinical significance. Correlation between immune markers and cortisol does not establish causation.
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
Roerink, Megan E, Roerink, Sean H P P, Skoluda, Nadine, van der Schaaf, Marieke E, Hermus, Ad R M M, van der Meer, Jos W M, et al. (2018). Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome.. Hormones and behavior. https://doi.org/10.1016/j.yhbeh.2018.05.016
BibTeX
@article{mecfsatlas-roerink-2018-hair-salivary,
author = {Roerink, Megan E and Roerink, Sean H P P and Skoluda, Nadine and van der Schaaf, Marieke E and Hermus, Ad R M M and van der Meer, Jos W M and Knoop, Hans and Nater, Urs M},
title = {Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome.},
journal = {Hormones and behavior},
year = {2018},
doi = {10.1016/j.yhbeh.2018.05.016},
note = {PubMed: 29807037},
url = {https://www.mecfsatlas.com/evidence/roerink-2018-hair-salivary},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/roerink-2018-hair-salivary
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