The HPA axis and the genesis of chronic fatigue syndrome

2004 ◽  
Vol 15 (2) ◽  
pp. 55-59 ◽  
Author(s):  
Anthony J. Cleare
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Hpa Axis ◽  
Chronic Fatigue ◽  
Fatigue Syndrome

scholarly journals Persistent burnout theory of chronic fatigue syndrome

2015 ◽  
Author(s):  
David Jameson
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Chronic Stress ◽  
Hpa Axis ◽  
Chronic Fatigue ◽  
Stress System ◽  
Occupational Burnout ◽  
Fatigue Syndrome ◽  
Growing Body ◽  
Physiological Abnormalities ◽  
Behavioural Factors

There is no agreement on the etiology of chronic fatigue syndrome (CFS), and the main theories (behavioural and viral/immune) do not satisfactorily explain all findings. A growing body of evidence shows that CFS appears to be a dysfunction of the stress system—and the hypothalamic–pituitary–adrenal (HPA) axis in particular—as a result of chronic stress. CFS shares many similarities to occupational burnout, including similar symptoms, physiological abnormalities and triggers. After a review of the available evidence, I hypothesize that CFS is a state of persistent burnout that remains after the initial stressors have been removed. This persistence may be due to a combination of a dysregulation of the HPA axis and behavioural factors.

scholarly journals The Neuroendocrinology of Chronic Fatigue Syndrome

2003 ◽  
Vol 24 (2) ◽  
pp. 236-252 ◽  
Author(s):  
Anthony J. Cleare
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Hpa Axis ◽  
Psychiatric Comorbidity ◽  
Chronic Fatigue ◽  
Functional Importance ◽  
Prospective Cohort Studies ◽  
Fatigue Syndrome ◽  
Cortisol Responses ◽  
The Many

Abstract Chronic fatigue syndrome (CFS) is a common and disabling problem; although most likely of biopsychosocial origin, the nature of the pathophysiological components remains unclear. There has been a wealth of interest in the endocrinology of this condition, which will be reviewed in this article. Most studied has been the hypothalamic-pituitary-adrenal (HPA) axis; although the quality of many studies is poor, the overall balance of evidence points to reduced cortisol output in at least some patients, with some evidence that this is linked to symptom production or persistence. There is evidence for heightened negative feedback and glucocorticoid receptor function and for impaired ACTH and cortisol responses to a variety of challenges. However, there is no evidence for a specific or uniform dysfunction of the HPA axis. Given the many factors that may impinge on the HPA axis in CFS, such as inactivity, sleep disturbance, psychiatric comorbidity, medication, and ongoing stress, it seems likely that HPA axis disturbance is heterogeneous and of multifactorial etiology in CFS. Studies assessing GH, dehydroepiandrostenedione and its sulfate, melatonin, leptin, and neuroendocrine-monoamine interactions are also reviewed. There is some evidence from these studies to suggest alterations of dehydroepiandrostenedione sulfate function and abnormal serotonin function in CFS, but whether these changes are of functional importance remains unclear. To obtain a clearer assessment of the etiological and pathophysiological relevance of endocrine changes in CFS, it is suggested that more prospective cohort studies be undertaken in groups at high risk for CFS, that patients with CFS are followed up into recovery, and that multidimensional assessments are undertaken to unravel the influence of the various confounding factors on the observed endocrine changes in CFS.

scholarly journals Salivary cortisol response to awakening in chronic fatigue syndrome

2004 ◽  
Vol 184 (2) ◽  
pp. 136-141 ◽  
Author(s):  
Amanda D. L. Roberts ◽  
Simon Wessely ◽  
Trudie Chalder ◽  
Andrew Papadopoulos ◽  
Anthony J. Cleare
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Hpa Axis ◽  
Salivary Cortisol ◽  
Area Under The Curve ◽  
Chronic Fatigue ◽  
Cortisol Response ◽  
Non Invasive ◽  
Fatigue Syndrome ◽  
Invasive Test ◽  
Response To Stress

BackgroundThere is accumulating evidence of hypothalamic–pituitary–adrenal (HPA) axis disturbances in chronic fatigue syndrome (CFS). The salivary cortisol response to awakening has been described recently as a non-invasive test of the capacity of the HPA axis to respond to stress. The results of this test correlate closely with those of more invasive dynamic tests reported in the literature; furthermore, it can be undertaken in a naturalistic setting.AimsTo assess the HPA axis using the salivary cortisol response to awakening in CFS.MethodWe measured salivary cortisol upon awakening and 10, 20, 30 and 60 min afterwards in 56 patients with CFS and 35 healthy volunteers.ResultsPatients had a lower cortisol response to awakening, measured by the area under the curve.ConclusionsThis naturalistic test of the HPA axis response to stress showed impaired HPA axis function in CFS.

scholarly journals Persistent burnout theory of chronic fatigue syndrome

2015 ◽  
Author(s):  
David Jameson
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Chronic Stress ◽  
Hpa Axis ◽  
Chronic Fatigue ◽  
Stress System ◽  
Occupational Burnout ◽  
Fatigue Syndrome ◽  
Growing Body ◽  
Physiological Abnormalities ◽  
Behavioural Factors

There is no agreement on the etiology of chronic fatigue syndrome (CFS), and the main theories (behavioural and viral/immune) do not satisfactorily explain all findings. A growing body of evidence shows that CFS appears to be a dysfunction of the stress system—and the hypothalamic–pituitary–adrenal (HPA) axis in particular—as a result of chronic stress. CFS shares many similarities to occupational burnout, including similar symptoms, physiological abnormalities and triggers. After a review of the available evidence, I hypothesize that CFS is a state of persistent burnout that remains after the initial stressors have been removed. This persistence may be due to a combination of a dysregulation of the HPA axis and behavioural factors.

Dysregulation of the HPA Axis in Chronic Fatigue Syndrome

2013 ◽  
Vol 4 (4) ◽  
pp. 275-279 ◽  
Author(s):  
Matthew R. Sorenson ◽  
Leonard Jason
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Hpa Axis ◽  
Chronic Fatigue ◽  
Fatigue Syndrome

Chronic fatigue syndrome in the psychiatric practice

2002 ◽  
Vol 14 (3) ◽  
pp. 127-133 ◽  
Author(s):  
A. Van Duyse ◽  
A. Mariman ◽  
C. Poppe ◽  
W. Michielsen ◽  
R. Rubens
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Hpa Axis ◽  
Psychiatric Comorbidity ◽  
Chronic Fatigue ◽  
Positive Influence ◽  
Psychiatric Practice ◽  
Behaviour Therapy ◽  
Psychiatric Interview ◽  
Fatigue Syndrome ◽  
Cognitive Behaviour

Background:Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70–80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFSAim:Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.Conclusions:Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic–pituitary–adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.

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