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Endocrine system
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==Relationship to ME/CFS == [[Hypothalamic-pituitary-adrenal axis]] (HPA) is the collaborative functioning between the hypothalamus and the pituitary gland. These tissues work together to regulate hormone production and release, and also moderate bodily functions such as temperature regulation, fluid balance, appetite and thirst detection. Hypofunction of the HPA has been identified as a problem experienced in [[ME/CFS]] patients. Lower cortisol levels were identified in ME/CFS patients than in healthy controls, and has been shown to be connected to [[Sleep dysfunction|decreased sleep]]<ref>{{Cite journal | last = Nijhof | first = Sanne L. | last2 = Rutten | first2 = Juliette M. T.M. | last3 = Uiterwaal | first3 = Cuno S. P.M. | last4 = Bleijenberg | first4 = Gijs | last5 = Kimpen | first5 = Jan L.L. | last6 = Putte | first6 = Elise M. van de | date = Apr 2014 | title = The role of hypocortisolism in chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/24636516|journal=Psychoneuroendocrinology|volume=42 | pages = 199–206|doi=10.1016/j.psyneuen.2014.01.017|issn=1873-3360|pmid=24636516}}</ref>. Exogenous [[cortisol]] administration was tested as a possible treatment however these results should be replicated due to the group’s use of solely the [[Fukuda criteria|Fukuda]] Assessment of ME/CFS (which may allow for error in diagnosis of the condition). Furthermore, several journals suggested [[Cognitive behavioral therapy|CBT]] as a feasible treatment option to increase cortisol levels, however due to the extensive literature questioning and undermining the utility of CBT in ME/CFS in overall treatment, other options should be explored in this research.<ref>{{Cite journal | last = Twisk | first = Frank N.M. | last2 = Maes | first2 = Michael | date = 2009 | title = A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS| url = https://www.ncbi.nlm.nih.gov/pubmed/19855350|journal=Neuro Endocrinology Letters|volume=30|issue=3 | pages = 284–299|issn=0172-780X|pmid=19855350}}</ref><ref>{{Cite journal | last = Núñez | first = Montserrat | last2 = Fernández-Solà | first2 = Joaquim | last3 = Nuñez | first3 = Esther | last4 = Fernández-Huerta | first4 = José-Manuel | last5 = Godás-Sieso | first5 = Teresa | last6 = Gomez-Gil | first6 = Esther | date = 2011-01-15 | title = Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up | url =https://link.springer.com/article/10.1007/s10067-010-1677-y|journal=Clinical Rheumatology|language=en|volume=30|issue=3 | pages = 381–389|doi=10.1007/s10067-010-1677-y|issn=0770-3198}}</ref>
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