ReviewNature reviews. Endocrinology2011
Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome.
Review in Nature reviews. Endocrinology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06232473 (Efficacy of Patient Education and Duloxetine, Alone or in Combination, for Patients With Multisystem Functional Somatic Disorder), which is not on this map. Cited by 106 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of Patient Education and Duloxetine, Alone or in Combination, for Patients With Multisystem Functional Somatic Disorder
Who cites it
106 citing papers in PubMed, 4 syntheses or guidelines pooled it, 274 citations in OpenAlex.
- Effect of nonpharmacologic therapies on depressive symptoms in patients with chronic fatigue syndrome: a network meta-analysis.Frontiers in psychiatry · 2025Pooled it
- Systematic Review of Mind-Body Interventions to Treat Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.Medicina (Kaunas, Lithuania) · 2021Pooled it
- Associations Between Psychological and Immunological Variables in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review.Frontiers in psychiatry · 2021Pooled it
- Central changes associated with chronic pelvic pain and endometriosis.Human reproduction updatePooled it
- Self-Soothing Touch Reduces Momentary Stress, Fatigue, and Loneliness Comparable to Brief Meditation: A Randomised Controlled Trial.Stress and health : journal of the International Society for the Investigation of Stress · 2026Trial
- Reduction of Glucocorticoid Receptor Function in Chronic Fatigue Syndrome.Mediators of inflammation · 2018Trial
- Trial
- Tracking post-infectious fatigue in clinic using routine Lab tests.BMC pediatrics · 2016Trial
- Hair cortisol concentration and basal heart rate variability differentiate long COVID from depressive disorders in youth.Comprehensive psychoneuroendocrinology · 2026Article
- Article
- Camel Milk Alleviates Chronic Fatigue Syndrome-like Symptoms in Mice by Modulating the Small Intestinal Microbiota and Inflammation.Foods (Basel, Switzerland) · 2026Article
- Long-Term Follow-Up of Women with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A 16-Year Longitudinal Study.Medicina (Kaunas, Lithuania) · 2026Article
- to extrapolation of primary absorbed compounds as multifunctional proxies of Zhiqiao ()-Houpo () herb pair.Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan · 2026Article
- Chronic stress and cognitive dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome: HPA axis dysregulation and hippocampal plasticity.Frontiers in neuroscience · 2026Review
- Insights into the Complex Biological Network Underlying Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.International journal of molecular sciences · 2025Review
- Mucosal Viruses in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Missing Piece of the Puzzle?International journal of molecular sciences · 2025Review
- The neuro-immune axis in cancer: from mechanisms to therapeutic opportunities.Journal of hematology & oncology · 2025Review
- Investigating the role of tripartite motif containing-21 and interleukin-6 in pro-Inflammatory symptom-associated heterogeneity within primary Sjögren's syndrome.Rheumatology and immunology research · 2025Article
- The dynamic trajectory of symptom networks in patients with acute pancreatitis during hospitalization.Frontiers in medicine · 2025Article
- Sex and disease severity-based analysis of steroid hormones in ME/CFS.Journal of endocrinological investigation · 2024Article
46 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The weight of current evidence supports the presence of the following factors related to hypothalamic-pituitary-adrenal (HPA) axis dysfunction in patients with chronic fatigue syndrome (CFS): mild hypocortisolism; attenuated diurnal variation of cortisol; enhanced negative feedback to the HPA axis; and blunted HPA axis responsiveness. Furthermore, HPA axis changes seem clinically relevant, as they are associated with worse symptoms and/or disability and with poorer outcomes to standard treatments for CFS. Regarding etiology, women with CFS are more likely to have reduced cortisol levels. Studies published in the past 8 years provide further support for a multifactorial model in which several factors interact to moderate HPA axis changes. In particular, low activity levels, depression and early-life stress appear to reduce cortisol levels, whereas the use of psychotropic medication can increase cortisol. Addressing these factors-for example, with cognitive behavioral therapy-can increase cortisol levels and is probably the first-line approach for correcting HPA axis dysfunction at present, as steroid replacement is not recommended. Given what is now a fairly consistent pattern of findings for the type of HPA axis changes found in CFS, we recommend that future work focuses on improving our understanding of the cause and relevance of these observed changes.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.