Van Den Eede, Filip, Moorkens, Greta, Van Houdenhove, Boudewijn et al. · Neuropsychobiology · 2007 · DOI
This review examined research on the stress-response system (called the HPA axis) in ME/CFS patients. Scientists found that many people with ME/CFS have lower-than-normal stress hormone levels and don't respond typically to stress. While it's unclear whether this hormone imbalance causes ME/CFS or develops because of it, the authors suggest it likely plays a role in how symptoms develop and persist.
Understanding HPA axis dysfunction in ME/CFS may explain why patients often feel unable to mount appropriate stress responses and may inform treatment approaches targeting hormone regulation. This review consolidates fragmented evidence and identifies whether hormone abnormalities are a core feature or secondary consequence, which is essential for developing targeted interventions.
This review does not prove that HPA axis dysfunction causes ME/CFS or that it occurs in all patients with the condition. The authors explicitly note methodological difficulties across studies and that the causal relationship remains unresolved—HPA abnormalities could be secondary to other disease mechanisms rather than primary drivers.
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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