Visser, J T, De Kloet, E R, Nagelkerken, L · Annals of the New York Academy of Sciences · 2000 · DOI
This study explores how stress hormones called glucocorticoids affect the immune system in ME/CFS patients. The researchers found evidence suggesting that in ME/CFS, these stress hormones may be shifting the immune system's balance in an unhelpful way—boosting certain types of immune responses while weakening others. This could help explain why ME/CFS patients experience ongoing immune system problems.
Understanding how stress hormones malfunction in ME/CFS could explain the characteristic shift toward Th2 immunity and away from Th1 cellular immunity observed in patients. If this mechanism is correct, it could eventually lead to treatments targeting HPA-axis dysfunction or immune rebalancing, potentially offering new therapeutic approaches for ME/CFS.
This theoretical paper does not provide direct experimental evidence proving that altered glucocorticoid regulation is the cause of immune dysfunction in ME/CFS. It cannot establish causation or definitively show that normalizing glucocorticoid signaling would reverse immune abnormalities. Further empirical studies are needed to test these mechanistic hypotheses in actual patient populations.
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
Visser, J T, De Kloet, E R, & Nagelkerken, L (2000). Altered glucocorticoid regulation of the immune response in the chronic fatigue syndrome.. Annals of the New York Academy of Sciences. https://doi.org/10.1111/j.1749-6632.2000.tb05453.x
BibTeX
@article{mecfsatlas-visser-2000-altered-glucocorticoid,
author = {Visser, J T and De Kloet, E R and Nagelkerken, L},
title = {Altered glucocorticoid regulation of the immune response in the chronic fatigue syndrome.},
journal = {Annals of the New York Academy of Sciences},
year = {2000},
doi = {10.1111/j.1749-6632.2000.tb05453.x},
note = {PubMed: 11268418},
url = {https://www.mecfsatlas.com/evidence/visser-2000-altered-glucocorticoid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/visser-2000-altered-glucocorticoid
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