Tanriverdi, F, Karaca, Z, Unluhizarci, K et al. · Stress (Amsterdam, Netherlands) · 2007 · DOI
This review examines how the stress response system (called the HPA axis) works differently in people with ME/CFS and fibromyalgia. The HPA axis is normally responsible for managing how your body responds to stress. Most studies show that in these conditions, the system is underactive and produces lower levels of cortisol (a stress hormone), though some studies have found different results.
Understanding HPA axis dysfunction is crucial for ME/CFS because it may explain why standard stress-response hormones are abnormal in this disease, potentially informing treatment approaches. If the low cortisol is the body's adaptive response rather than a defect, it changes how researchers think about whether to treat this finding and how.
This review does not establish causation—whether HPA axis underactivity causes ME/CFS symptoms or results from the chronic illness itself. It also cannot definitively resolve contradictory findings in the literature or determine which testing methods are most accurate. The study does not prove that HPA axis dysfunction is the primary mechanism driving ME/CFS pathology.
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
Tanriverdi, F, Karaca, Z, Unluhizarci, K, & Kelestimur, F (2007). The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome.. Stress (Amsterdam, Netherlands). https://doi.org/10.1080/10253890601130823
BibTeX
@article{mecfsatlas-tanriverdi-2007-hypothalamo-pituitary,
author = {Tanriverdi, F and Karaca, Z and Unluhizarci, K and Kelestimur, F},
title = {The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome.},
journal = {Stress (Amsterdam, Netherlands)},
year = {2007},
doi = {10.1080/10253890601130823},
note = {PubMed: 17454963},
url = {https://www.mecfsatlas.com/evidence/tanriverdi-2007-hypothalamo-pituitary},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/tanriverdi-2007-hypothalamo-pituitary
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