Cortisol

Cortisol is a steroid hormone released by the adrenal glands which sit upon the kidneys. It is the main stress hormone in the human body. Release of cortisol is controlled by the hypothalamus, a part of the brain.

Cortisol has several known roles in the human body: aiding in metabolism, reducing inflammation, assisting electrolyte balance, stimulating gastric-acid secretion and controlling one's sleep/wake cycle. Cortisol given as a medicine is known as hydrocortisone.

Normal blood level of cortisol vary throughout the day, with the highest level in the morning upon awakening and lowest level around midnight. Levels can also rise in reaction to stress or low blood sugar. Some health conditions can cause an increase in cortisol, such as depression and Cushing syndrome. Other health conditions can cause a decrease, such as Addison's disease and ME/CFS.

Findings
Hypocortisolism (a low cortisol level) frequently occurs in patients with ME/CFS, confirmed by studies measuring cortisol levels and in urine and saliva. In addition to general hypocortisolism, ME/CFS patients have a decreased cortisol awakening response, ie, morning cortisol levels peak later compared to healthy controls. In 2018, Roerink, et al, studied hair cortisol concentrations in CFS patients to assess if hypocortisolism was a prolonged phenomenon. They found that there was a trend of lower hair cortisol concentrations in CFS patients, thus suggesting that hypocortisolism was long-term in ME/CFS. As people with ME/CFS improved, their hypocortisolism improved.

Clinical trials
A 1998 double-blind, randomized, placebo-controlled trial found that low dose hydrocortisone led to a statistical improvement in one subjective score, the Wellness scale. No statistical evidence of improvement was seen with the other self-rating scales. The authors concluded that: although hydrocortisone treatment was associated with some improvement in symptoms of CFS, the degree of adrenal suppression precludes its practical use for CFS.

In 1999, the Institute of Psychiatry, London, did a randomized crossover trial, in which Simon Wessely was an author, where low dose hydrocortisone treatments given to patients with chronic fatigue syndrome were found to reduce fatigue scores and that 28% of patients in the treatment group had reductions in scores that brought them to or close to normal in the short term.

A 2003 double-blind, randomized, placebo-controlled trial of hydrocortisone in combination with fludrocortisone found no difference in self-reported outcomes from when patients received the placebo vs. the medication.

Notable studies

 * 1998, Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers (Abstract)
 * 2000, Review article - Chronic Fatigue Syndrome: A Dysfunction of the Hypothalamic-Pituitary-Adrenal Axis (Abstract)
 * 2014, The role of hypocortisolism in chronic fatigue syndrome (Abstract)
 * 2015, Salivary cortisol responses to household tasks among couples with unexplained chronic fatigue (Full Text)
 * 2018, Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome (Abstract)
 * 2018, A State-Space Investigation of Cortisol Alterations in Chronic Fatigue Syndrome

Learn more

 * What is cortisol? - WebMD
 * All You Need to Know About Cortisol and Its Health Effects
 * The Cortisol, PEM and Stress Management Link in Chronic Fatigue Syndrome by Cort Johnson in Health Rising