Tomas, Cara, Newton, Julia, Watson, Stuart · ISRN neuroscience · 2013 · DOI
This review examined how ME/CFS affects the HPA axis, a system in the brain that controls stress hormones like cortisol. Researchers found that many ME/CFS patients have problems with this system, including lower cortisol levels and changes in how their bodies respond to stress. The review suggests that genetics, past trauma, and oxidative stress may play a role, and notes that women are more commonly affected than men.
Understanding HPA axis dysfunction is crucial because it may explain some ME/CFS symptoms like fatigue and impaired stress response, and could point toward new treatments targeting hormonal regulation. If HPA axis problems are confirmed as causal, this could lead to more personalized therapeutic approaches beyond current standard treatments.
This review does not prove that HPA axis dysfunction causes ME/CFS—it only shows the two are associated. The study cannot establish whether the hormonal problems are a primary cause, a consequence of illness, or an unrelated finding. It also does not demonstrate that treating HPA axis dysfunction would improve ME/CFS symptoms.
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 →
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Primary citation
Tomas, Cara, Newton, Julia, & Watson, Stuart (2013). A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome.. ISRN neuroscience. https://doi.org/10.1155/2013/784520
BibTeX
@article{mecfsatlas-tomas-2013-review-hypothalamic,
author = {Tomas, Cara and Newton, Julia and Watson, Stuart},
title = {A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome.},
journal = {ISRN neuroscience},
year = {2013},
doi = {10.1155/2013/784520},
note = {PubMed: 24959566},
url = {https://www.mecfsatlas.com/evidence/tomas-2013-review-hypothalamic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/tomas-2013-review-hypothalamic
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