Urinary Free Cortisol in Chronic Fatigue Syndrome

Cleare, Anthony J.; Blair, Dorothy; Chambers, Susan; Wessely, Simon

doi:10.1176/appi.ajp.158.4.641

Cited by 80 publications

(55 citation statements)

References 7 publications

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“…It has been proposed that with time, longstanding strain on the HPA axis may lead to hypocortisolism [15][16][17][18]. Although the mechanisms underlying this type of dysregulation in humans are not well understood, data indicate that such conditions as posttraumatic stress disorder (PTSD), CFS, fibromyalgia, and VE are characterised by excessively low levels of cortisol [19][20][21][22][23][24][25][26][27][28][29][30][31]. Some studies, however, have failed to demonstrate differences in cortisol levels between CFS patients and controls [32], and others [33] have even reported the opposite pattern, i.e., raised salivary cortisol in CFS.…”

Section: Introductionmentioning

confidence: 99%

The morning salivary cortisol response in burnout

Grossi¹,

Perski²,

Ekstedt³

et al. 2005

Journal of Psychosomatic Research

140

104

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Section: Introductionmentioning

confidence: 99%

The morning salivary cortisol response in burnout

Grossi¹,

Perski²,

Ekstedt³

et al. 2005

Journal of Psychosomatic Research

140

104

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“…Hypothyroid patients also have clear evidence of CRH hyposecretion. [8][9][10][11] Finally, the hypothesis that antidepressants exert their clinical effects through direct modulation of the glucocorticoid hormones and their receptor is one of the most striking and innovative models of the mechanism of action of this class of drugs. [12][13] We will review the evidences supporting that: 1) HPA axis hyperactivity plays an important role in the pathogenesis of major depression; 2) this hyperactivity is mainly due to an impaired feedback inhibition by circulating glucocorticoid hormones on the HPA axis; 3) this impaired feedback inhibition is related to a decreased function of the glucocorticoid receptors (GR), which mediate the effects of glucocorticoid hormones, including the negative feedback on the HPA axis; and 4) antidepressants act by reversing these changes in the GR function and thus normalising HPA axis hyperactivity in patients with major depression.…”

Section: Introductionmentioning

confidence: 99%

O eixo hipotálamo-pituitária-adrenal, a função dos receptores de glicocorticóides e sua importância na depressão

Juruena

Cleare

Pariante

2004

Rev. Bras. Psiquiatr.

143

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Objective: Changes in the hypothalamic-pituitary-adrenocortical (HPA) system are characteristic of depression. Because the effects of glucocorticoids are mediated by intracellular receptors including, most notably, the glucocorticoid receptor (GR), several studies have examined the number and/or function of GRs in depressed patients. Methods: Review scientific evidences have consistently demonstrated that GR function is impaired in major depression, resulting in reduced GR IntroductionHormones play a critical role in the development and expression of a wide range of behaviours. One aspect of the influence of hormones on behaviour is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs, particularly in major depression. Of all endocrine axes, the hypothalamic-pituitary-adrenal (HPA) axis has been the most widely evaluated. 1,2 The HPA axis plays a fundamental role in the response to external and internal stimuli including psychological stressors. Abnormalities in the function of the HPA axis have been described in people experiencing psychiatric disorders. Moreover, is well known the fundamental role of stress in precipitating episodes of psychiatric disorders in predisposed individuals. 1 These abnormalities seem related to changes in the ability of circulating glucocorticoids to exert their negative feedback on the secretion of HPA hormones through binding to the mineralocorticoid receptor (MR) and the glucocorticoid receptor (GR) in HPA tissues. 2,3,6 In fact, previous studies have described both an impaired HPA negative feedback, leading to hypercortisolemia, as in melancholic depression. 2,6 In addition to melancholic depression, a spectrum of other conditions may be associated with increased and prolonged activation of the HPA axis, including anorexia nervosa with or without malnutrition, obsessive-compulsive disorder, panic anxiety, chronic active alcoholism, alcohol and narcotic withdrawal, excessive exercising, poorly controlled diabetes mellitus, childhood sexual abuse and hyperthyroidism. 7 Another group of states is characterized by hypoactivation of the stress system, rather than sustained activation, in which chronically reduced secretion of CRH may result in pathological hypoarousal and an enhanced HPA negative feedback. Patients with post-traumatic stress disorder, atypical, seasonal depression and the chronic fatigue syndrome fall in this category (see Table 1). Similarly, patients with fibromyalgia have decreased urinary free

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“…Furthermore, neurobiological investigations have repeatedly shown hypothalamo-pituitary-adrenal axis functioning to be perturbed in CFS as well as FM, implying a lack of reactivity of this axis and resulting in decreased cortisol secretion [24, 25, 26]. …”

Section: Introductionmentioning

confidence: 99%

Daily Hassles Reported by Chronic Fatigue Syndrome and Fibromyalgia Patients in Tertiary Care: A Controlled Quantitative and Qualitative Study

Houdenhove

Neerinckx²,

Onghena

et al. 2002

Psychother Psychosom

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Background: This study aimed at providing insight in the frequency, emotional impact and nature of daily hassles, experienced by patients suffering from chronic fatigue syndrome (CFS) and/or fibromyalgia (FM), compared with patients with a chronic organic disease. Methods: One hundred and seventy-seven CFS/FM patients, 26 multiple sclerosis (MS) and 26 rheumatoid arthritis (RA) patients were investigated within 2–6 months after diagnosis. All patients completed a self-report questionnaire assessing daily hassles and associated distress, a visual analogue scale assessing fatigue and pain and a depression and anxiety questionnaire. Results: CFS/FM patients show a higher frequency of hassles, higher emotional impact and higher fatigue, pain, depression and anxiety levels compared with MS/RA patients. Three hassle themes dominate in the CFS/FM group: dissatisfaction with oneself, insecurity and a lack of social recognition. In contrast, hassles reported by MS/RA patients show a much larger diversity and are not focused on person-dependent problems. Conclusions: Patients recently diagnosed as suffering from CFS and/or FM are highly preoccupied and distressed by daily hassles that have a severe impact on their self-image, as well as their personal, social and professional functioning. An optimal therapeutic approach of CFS and FM should take account of this heavy psychosocial burden, which might refer to core themes of these patients’ illness experience.

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Urinary Free Cortisol in Chronic Fatigue Syndrome

Abstract: There is mild hypocortisolism in chronic fatigue syndrome. Whether a primary feature or secondary to other factors, hypocortisolism may be one factor contributing to the symptoms of chronic fatigue syndrome.

Cited by 80 publications

References 7 publications

The morning salivary cortisol response in burnout

The morning salivary cortisol response in burnout

O eixo hipotálamo-pituitária-adrenal, a função dos receptores de glicocorticóides e sua importância na depressão

Daily Hassles Reported by Chronic Fatigue Syndrome and Fibromyalgia Patients in Tertiary Care: A Controlled Quantitative and Qualitative Study

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