Scott, L V, Medbak, S, Dinan, T G · Clinical endocrinology · 1998 · DOI
This study tested whether people with ME/CFS have a subtle problem with their stress hormone system, specifically the pituitary gland's ability to signal the adrenal glands to release cortisol. Using a sensitive test with a very small dose of ACTH (a hormone that triggers cortisol release), researchers found that people with ME/CFS showed a weaker cortisol response than healthy people, suggesting their adrenal system may not be functioning optimally.
This study provides biological evidence that ME/CFS involves dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, a key stress-response system. Understanding whether HPA dysfunction is a characteristic feature of ME/CFS could eventually inform treatment approaches and help validate ME/CFS as a physiological condition rather than a psychiatric one.
This study does not prove that HPA axis dysfunction causes ME/CFS symptoms or is the primary driver of the illness. The cross-sectional design cannot establish causality, and the finding of abnormal cortisol response does not explain whether this is a primary defect or secondary to other pathophysiological processes. Additionally, the authors' own concerns about test reliability and varying normal cutoffs across studies limit the conclusiveness of the findings.
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
Scott, L V, Medbak, S, & Dinan, T G (1998). The low dose ACTH test in chronic fatigue syndrome and in health.. Clinical endocrinology. https://doi.org/10.1046/j.1365-2265.1998.00418.x
BibTeX
@article{mecfsatlas-scott-1998-low-dose,
author = {Scott, L V and Medbak, S and Dinan, T G},
title = {The low dose ACTH test in chronic fatigue syndrome and in health.},
journal = {Clinical endocrinology},
year = {1998},
doi = {10.1046/j.1365-2265.1998.00418.x},
note = {PubMed: 9713562},
url = {https://www.mecfsatlas.com/evidence/scott-1998-low-dose},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/scott-1998-low-dose
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