Ursini, F, Succurro, E, Grembiale, A et al. · La Clinica terapeutica · 2010
This review examines whether problems with the HPA axis—a system in your brain and body that manages stress and energy—might explain ME/CFS symptoms. The HPA axis controls cortisol and other hormones that help your body respond to stress and maintain energy levels. This article summarizes what scientists have found so far about whether HPA axis dysfunction could be a key cause of ME/CFS.
Understanding whether the HPA axis is dysfunctional in ME/CFS is crucial because it could point toward new diagnostic markers and treatments targeting hormone regulation. If HPA axis dysfunction is confirmed as part of ME/CFS pathogenesis, it might explain why patients experience persistent fatigue and why stress can worsen symptoms, potentially leading to more targeted therapeutic interventions.
This review does not prove that HPA axis dysfunction causes ME/CFS—it only examines whether evidence supports a possible role. The study cannot establish whether any observed HPA axis abnormalities are a primary cause, a secondary consequence of illness, or simply a correlation. New empirical research is needed to determine causation and the clinical significance of HPA axis changes in ME/CFS patients.
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
Ursini, F, Succurro, E, Grembiale, A, Gagliardi, D A P, & Arturi, F (2010). [The HPA axis in the pathogenesis of chronic fatigue syndrome].. La Clinica terapeutica. https://pubmed.ncbi.nlm.nih.gov/20949245/
BibTeX
@article{mecfsatlas-ursini-2010-hpa-axis,
author = {Ursini, F and Succurro, E and Grembiale, A and Gagliardi, D A P and Arturi, F},
title = {[The HPA axis in the pathogenesis of chronic fatigue syndrome].},
journal = {La Clinica terapeutica},
year = {2010},
note = {PubMed: 20949245},
url = {https://www.mecfsatlas.com/evidence/ursini-2010-hpa-axis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/ursini-2010-hpa-axis
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