Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-29T18:26:31.145Z Has data issue: false hasContentIssue false
  • English
  • Français

Glucocorticoids and glucocorticoid receptors: mediators of fatigue?

Published online by Cambridge University Press:  24 June 2014

A. J. Cleare
A. J. Cleare*
Affiliation:
Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, The Institute of Psychiatry, London, UK and Affective Disorders Unit, Maudsley Hospital, London, UK
*
Anthony J Cleare, Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, Institute of Psychiatry, London SE5 8AF, UK. Tel: 020 78485130; Fax: 020 78485408; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Fatigue is a common problem; when chronic and disabling, subjects can be categorized as having chronic fatigue syndrome (CFS). Whilst it is most likely a multifactorial condition of biopsychosocial origin, the nature of the pathophysiological component remains unclear. There has been a wealth of interest in the possible hypothalamo–pituitary–adrenal (HPA) axis dysfunction in CFS, and whether such changes may mediate fatigue. On balance, there appears to be reduced cortisol output in a proportion of patients, together with heightened negative feedback and glucocorticoid receptor function. There is evidence for impaired adrenocorticotropic hormone (ACTH) and cortisol responses to a variety of challenges. However, there is no evidence for a specific or uniform dysfunction of the HPA axis. Evidence that these changes may be related to symptom production comes from randomized controlled trials of glucocorticoid replacement therapy, which have shown improvements in fatigue and disability. 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 there is not a single or specific change to the HPA axis in CFS and that the observed HPA axis disturbances are of multifactorial etiology. This is further supported by a comparison of neuroendocrine findings in other conditions in which fatigue is prominent, showing both similarities and differences with the pattern in CFS.

Keywords

chronic fatigue syndromeCortisolhydrocortisonehypothalmo–pituitary–adrenal axisneuroendocrine
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 15 , Issue 6 , December 2003 , pp. 341 - 353
Copyright
Copyright © 2003 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lewis, G, Wessely, S.The epidemiology of fatigue: more questions than answers. J Epid Comm Health 1992;46: 92–97. CrossRefGoogle ScholarPubMed
McDonald, E, David, A, Pelosi, A, Mann, A.Chronic fatigue in primary care attenders. Psychol Med 1993;23: 987–998.CrossRefGoogle ScholarPubMed
Wessely, S, Hotopf, M, Sharpe, M.Chronic fatigue and its syndromes. Oxford: Oxford University Press, 1998. Google ScholarPubMed
Fukuda, K, Straus, S, Hickie, I, Sharpe, M, Dobbins, J, Komaroff, A.The chronic fatigue syndrome. a comprehensive approach to its definition and study. Ann Int Med 1994;121: 953–959.CrossRefGoogle ScholarPubMed
Wessely, S.The epidemiology of chronic fatigue syndrome. Epidemiol Rev 1995;17: 139–151.CrossRefGoogle ScholarPubMed
Tattersall, R.Hypoadrenia, or ‘a bit of Addison's disease'. Med History 1999;43: 450–457. CrossRefGoogle ScholarPubMed
Brosnan, CM, Cowing, NFC.Addison's Dis Br Med J 1996;312: 1085–1087. CrossRefGoogle Scholar
Avgerinos, PC, Chrousos, GP, Nieman, LK, Oldfield, EH, Loriaux, DL, Cutler, BG.The CRH test in the postoperative evaluation of patients with Cushing's syndrome. J Clin Endocrinol Metab 1987;65: 906–913.CrossRefGoogle ScholarPubMed
Riordain, D, Farley, D, Young, W, Grant, C, van Heerden, J.Long term outcome of bilateral adrenalectomy in patients with Cushing's syndrome. Surgery 1994;116: 1088–1093.Google Scholar
Baxter, JD, Tyrel, JB.The adrenal cortex. In: Felig, P, Baxter, JD, Broadus, AE, Frohman, LA, eds. Endocrinology and metabolism. New York: McGraw-Hill, 1981: 385–510. Google Scholar
Poteliakhoff, A.Adrenocortical activity and some clinical findings in chronic fatigue. J Psychosom Res 1981;25: 91–95.CrossRefGoogle ScholarPubMed
Cleare, AJ, Bearn, J, Allain, Tet al. Contrasting neuroendocrine responses in depression and chronic fatigue syndrome. J Affect Disord 1995;34: 283–289.CrossRefGoogle ScholarPubMed
Bearn, J, Allain, T, Coskeran, Pet al. Neuroendocrine responses to d-fenfluramine and insulin-induced hypoglycemia in chronic fatigue syndrome. Biol Psychiatry 1995;37: 245–252.CrossRefGoogle ScholarPubMed
Yatham, L, Morehouse, R, Chisholm, B, Haase, D, MacDonald, D, Marrie, T.Neuroendocrine assessment of serotonin (5-HT) function in chronic fatigue syndrome. Can J Psych 1995;40: 93–96. Google ScholarPubMed
Dinan, TG, Majeed, T, Lavelle, E, Scott, LV, Berti, C, Behan, P.Blunted serotonin-mediated activation of the hypothalamic-pituitary-adrenal axis in chronic fatigue syndrome. Psychoneuroendocrinology 1997;22: 261–267.CrossRefGoogle ScholarPubMed
Kuratsune, H, Yamaguti, K, Sawada, Met al. Dehydroepiandrosterone sulfate deficiency in chronic fatigue syndrome. Int J Mol Med 1998;1: 143–146.Google ScholarPubMed
Scott, LV, Medbak, S, Dinan, TG.Blunted adrenocorticotropin and cortisol responses to corticotropin- releasing hormone stimulation in chronic fatigue syndrome. Acta Psychiatr Scand 1998;97: 450–457.CrossRefGoogle ScholarPubMed
Scott, LV, Medbak, S, Dinan, TG.The low dose adrenocorticotropin test in chronic fatigue syndrome and in health. Clin Endocrinol 1998;48: 733–737. CrossRefGoogle ScholarPubMed
Scott, L, Burnett, F, Medback, S, Dinan, T.Naloxone-mediated activation of the hypothalamic-pituitary-adrenal axis in chronic fatigue syndrome. Psychol Med 1998;28: 285–293.CrossRefGoogle ScholarPubMed
Scott, LV, Medbak, S, Dinan, TG.Desmopressin augments pituitary-adrenal responsivity to corticotropin-releasing hormone in subjects with chronic fatigue syndrome and in healthy volunteers. Biol Psychiatry 1999;45: 1447–1454.CrossRefGoogle ScholarPubMed
Scott, LV, Salahuddin, F, Cooney, J, Svec, F, Dinan, TG.Differences in adrenal steroid profile in chronic fatigue syndrome, in depression and in health. J Affect Disord 1999;54: 129–137.CrossRefGoogle ScholarPubMed
Kavelaars, A, Kuis, W, Knook, L, Sinnema, G, Heijnen, CJ.Disturbed neuroendocrine–immune interactions in chronic fatigue syndrome. J Clin Endocrinol Metabol 2000; 85: 692–696. Google ScholarPubMed
van Rensburg, SJ, Potocnik, FC, Kiss, Tet al. Serum concentrations of some metals and steroids in patients with chronic fatigue syndrome with reference to neurological and cognitive abnormalities. Brain Res Bull 2001;55: 319–325.CrossRefGoogle ScholarPubMed
Cleare, AJ, Miell, J, Heap, Eet al. Hypothalamo-Pituitary-Adrenal axis function in chronic fatigue syndrome, and the effects of low-dose hydrocortisone therapy. J Clin Endocrinol Metabol 2001; 86: 3545–3554. CrossRefGoogle ScholarPubMed
Ottenweller, JE, Sisto, SA, McCarty, RC, Natelson, BH.Hormonal responses to exercise in chronic fatigue syndrome. Neuropsychobiology 2001;43: 34–41.CrossRefGoogle ScholarPubMed
Gaab, J, Huster, D, Peisen, Ret al. Hypothalamus-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological and pharmacological stimulation. Psychosom Med, 2002;64: 951–962. Google Scholar
Kirschbaum, C, Hellhammer, DH.Salivary cortisol in psychoneuroendocrine research. Recent developments and applications. Psychoneuroendocrinology 1994;19: 313–333.CrossRefGoogle ScholarPubMed
Altemus, M, Dale, JK, Michelson, D, Demitrack, MA, Gold, PW, Straus, SE.Abnormalities in response to vasopressin infusion in chronic fatigue syndrome. Psychoneuroendocrinology 2001;26: 175–188.CrossRefGoogle ScholarPubMed
Demitrack, M, Dale, J, Straus, Set al. Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. J Clin Endocrinol Metab 1991;73: 1224–1234.CrossRefGoogle ScholarPubMed
Moorkens, G, Berwaerts, J, Wynants, H, Abstract, R.Characterization of pituitary function with emphasis on GH secretion in the chronic fatigue syndrome. Clin Endocrinol 2000;53: 99–106. CrossRefGoogle ScholarPubMed
Hamilos, DL, Nutter, D, Gershtenson, Jet al. Core body temperature is normal in chronic fatigue syndrome. Biol Psychiatry 1998;43: 293–302.CrossRefGoogle ScholarPubMed
Racciatti, D, Sensi, S, De Remigis, P, Barberio, A, Sciascio, T, Pizzigallo, E.Neuroendocrine aspects of chronic fatigue syndrome. Am J Medical 1998. Google Scholar
MacHale, SM, Cavanagh, JT, Bennie, J, Carroll, S, Goodwin, GM, Lawrie, SM.Diurnal variation of adrenocortical activity in chronic fatigue syndrome. Neuropsychobiology 1998;38: 213–217.CrossRefGoogle ScholarPubMed
Scott, L, Dinan, T.Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers. J Affect Disord 1998;47: 49–54.CrossRefGoogle ScholarPubMed
Cleare, AJ, Blair, D, Chambers, S, Wessely, S.Urinary free cortisol in chronic fatigue syndrome. Am J Psychiatry 2001;158: 641–643.CrossRefGoogle ScholarPubMed
Young, Ah, Sharpe, M, Clements, A, Dowling, B, Hawton, KE, Cowen, PJ.Basal activity of the hypothalamic-pituitary-adrenal axis in patients with the chronic fatigue syndrome (neurasthenia). Biol Psychiatry 1998, 43: 236–237. Google Scholar
Wood, B, Wessely, S, Papadopoulos, A, Poon, L, Checkley, S.Salivary cortisol profiles in chronic fatigue syndrome. Neuropsychobiology 1998;37: 1–4.CrossRefGoogle ScholarPubMed
Strickland, P, Morriss, R, Wearden, A, Deakin, W.A comparison of salivary cortisol in chronic fatigue syndrome, community depression and healthy controls. J Affect Disord 1998;47: 191–194.CrossRefGoogle ScholarPubMed
Gaab, J, Hüster, D, Peisen, Ret al. The low dose dexamethasone suppression test in chronic fatigue syndrome and health. Psychosom Med 2002;64: 311–318,.CrossRefGoogle ScholarPubMed
Thompson, LM, Rubin, RT, McCracken, JT.Neuroendocrine aspects of primary endogenous depression. 12. Receiver operating characteristics and kappa analyses of serum and urine cortisol measure in patients and matched controls. Psychoneuroendocrinology 1992;17: 507–515.CrossRefGoogle Scholar
Murphy, BE P.Urinary free cortisol determinations: what they measure. Endocrinologist 2002;12: 143–150. CrossRefGoogle Scholar
Raven, P, Taylor, NF.Sex differences in the human metabolism of cortisol. Endocr Res 1996;22: 751–755.CrossRefGoogle ScholarPubMed
Harvey, A, Purdie, G, Bushnell, J, Ellis, P. Are cortisol levels low in chronic fatigue syndrome? A meta-analysis. Third International Clinical and Scientific Meeting on CFS/ME, Sydney, Australia, 2001. Google Scholar
Scott, LV, Teh, J, Reznek, R, Martin, A, Sohaib, A, Dinan, TG.Small adrenal glands in chronic fatigue syndrome: a preliminary computer tomography study. Psychoneuroendocrinology 1999;24: 759–768.CrossRefGoogle ScholarPubMed
Hamilos, DL, Nutter, D, Gershtenson, Jet al. Circadian rhythm of core body temperature in subjects with chronic fatigue syndrome. Clin Physiol 2001;21: 184.CrossRefGoogle ScholarPubMed
Papadopoulos, E, Crofford, LJ, Engleberg, NCet al. Impaired HPA axis activity in chronic fatigue syndrome and fibromyalgia. Biol Psychiatry 1997;41: 29S. Google Scholar
Demitrack, M, Crofford, L.Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann NY Acad Sci 1998;840: 684–697.CrossRefGoogle ScholarPubMed
Hyyppa, M, Lindholm, T, Lehtinen, V, Puukka, P.Self-perceived fatigue and cortisol secretion in a community sample. J Psychosom Res 1993;37: 589–594.CrossRefGoogle Scholar
Poland, RE, Lin, K-M, Lutchmansingh, P, McCracken, JP.Biological Markers in CFS and neurasthenia. X. Madrid, Spain: World Congress of Psychiatry, 1996. Google Scholar
Lavelle, E, Dinan, TG.Hypothalamo-pituitary- adrenal axis function in chronic fatigue syndrome. a study of fast feedback mechanisms. Dublin: Royal College of Surgeons of Ireland Research Meeting, 1996. Google Scholar
Pruessner, JC, Hellhammer, DH, Kirschbaum, C.Burnout, perceived stress, and cortisol responses to awakening. Psychosom Med 1999;61: 197–204.CrossRefGoogle ScholarPubMed
Yehuda, R, Boisoneau, D, Lowy, MT, Giller, EL Jr.Dose–response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder. Arch Gen Psychiatry 1995;52: 583–593.CrossRefGoogle ScholarPubMed
Goenjian, AK, Yehuda, R, Pynoos, RSet al. Basal cortisol, dexamethasone suppression of cortisol, and MHPG in adolescents after the 1988 earthquake in Armenia. Am J Psychiatry 1996;153: 929–934.Google ScholarPubMed
Stein, MB, Yehuda, R, Koverola, C, Hanna, C.Enhanced dexamethasone suppression of plasma cortisol in adult women traumatized by childhood sexual abuse. Biol Psychiatry 1997;42: 680–686.CrossRefGoogle ScholarPubMed
Heim, C, Ehlert, U, Hanker, JP, Hellhammer, DH.Abuse-related posttraumatic stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in women with chronic pelvic pain. Psychosom Med 1998;60: 309–318.CrossRefGoogle ScholarPubMed
Visser, J, Blauw, B, Hinloopen, Bet al. CD4 T lymphocytes from patients with chronic fatigue syndrome have decreased interferon-gamma production and increased sensitivity to dexamethasone. J Infect Dis 1998;177: 451–454.CrossRefGoogle ScholarPubMed
Visser, J, Lentjes, E, Haspels, Iet al. Increased sensitivity to glucocorticoids in peripheral blood mononuclear cells of chronic fatigue syndrome patients, without evidence for altered density or affinity of glucocorticoid receptors. J Invest Med 2001;49: 195–204. CrossRefGoogle ScholarPubMed
Taerk, G, Toner, B, Salit, I, Garfinkel, P, Ozersky, S.Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). Int J Psych Med 1987;17: 49–56. CrossRefGoogle Scholar
Majeed, T, Dinan, T, Thakore, J, Gray, C, Behan, P.Defective dexamethasone induced growth hormone release in chronic fatigue syndrome; evidence for glucocorticoid receptor resistance and lack of plasticity? Irish Coll Phys Surg 1995;24: 20–2424. Google Scholar
Hudson, M, Cleare, AJ.The 1microg short Synacthen test in chronic fatigue syndrome. Clin Endocrinol 1999;51: 625–630. CrossRefGoogle ScholarPubMed
Debold, CR, Sheldon, WR, Decherney, GSet al. Argenine vasopressin potentiates adrenocorticotrophin release induced by corticotropin releasing factor. J Clin Invest 1984;73: 533–538.CrossRefGoogle Scholar
Salata, RA, Jarrett, DB, Verbalis, JG, Robinson, AG.Vasopressin stimulation of adrenocorticotropin hormone (ACTH) in humans. In vivo bioassay of corticotropin-releasing factor (CRF) which provides evidence for CRF mediation of the diurnal rhythm of ACTH. J Clin Invest 1988;81: 766–774.CrossRefGoogle ScholarPubMed
Bakheit, AM, Behan, PO, Watson, WS, Morton, JJ.Abnormal arginine-vasopressin secretion and water metabolism in patients with postviral fatigue syndrome. Acta Neurol Scand 1993;87: 234–238.CrossRefGoogle ScholarPubMed
McKenzie, R, O'Fallon, A, Dale, Jet al. Low-dose hydrocortisone treatment of chronic fatigue syndrome: results of a placebo-controlled study of its efficacy and safety. J Am Med Assoc 1998;280: 1061–1066. CrossRefGoogle Scholar
Cleare, AJ, Heap, E, Malhi, GS, Wessely, S, O'Keane, V, Miell, J.Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial. Lancet 1999; 353: 455–458.CrossRefGoogle ScholarPubMed
Miell, JP, Englaro, P, Blum, WF.Dexamethasone induces an acute and sustained rise in circulating leptin levels in normal human subjects. Horm Metab Res 1996;28: 704–707.CrossRefGoogle ScholarPubMed
Cleare, AJ, Sookdeo, S, Jones, J, O'Keane, V, Miell, J.Plasma leptin in chronic fatigue syndrome, and a placebo-controlled study of the effects of low-dose hydrocortisone on leptin secretion. Clin Endocrinol 2001;55: 113–119. CrossRefGoogle Scholar
Lawrie, S, MacHale, S, Power, M, Goodwin, G.Is the chronic fatigue syndrome best understood as a primary disturbance of the sense of effort? Psychol Med 1997; 27: 995–999.CrossRefGoogle ScholarPubMed
Vercoulen, JH, Bazelmans, E, Swanink, CMet al. Physical activity in chronic fatigue syndrome: assessment and its role in fatigue. J Psychiatr Res 1997; 31: 661–673.CrossRefGoogle ScholarPubMed
van der Werf, SP, Prins, JB, Vercoulen, Jh, van der Meer, JW, Bleijenberg, G.Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. J Psychosom Res 2000;49: 373–379.CrossRefGoogle ScholarPubMed
Prins, J, Bleijenberg, G, Bazelmans, Eet al. Cognitive behaviour therapy for chronic fatigue syndrome: a multicenter randomised controlled trial. Lancet 2001;357: 841–847.CrossRefGoogle ScholarPubMed
Dinan, TG.Glucocorticoids and the genesis of depressive illness. A psychobiological model. Br J Psychiatry 1994;164: 365–3671.CrossRefGoogle ScholarPubMed
Gold, PW, Licinio, J, Wong, ML, Chrousos, GP.Corticotropin releasing hormone in the pathophysiology of melancholic and atypical depression and in the mechanism of action of antidepressant drugs. Ann NY Acad Sci 1995;771: 716–729.CrossRefGoogle ScholarPubMed
Heim, C, Ehlert, U, Hellhammer, DH.The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 2000;25: 1–35.CrossRefGoogle ScholarPubMed
Abelson, JL, Curtis, GC.Hypothalamic-pituitary-adrenal axis activity in panic disorder. Arch General Psychiatry 1996;53: 323–331. CrossRefGoogle ScholarPubMed
Spath Schwalbe, E, Scholler, T, Kern, W, Fehm, HL, Born, J.Nocturnal adrenocorticotropin and cortisol secretion depends on sleep duration and decreases in association with spontaneous awakening in the morning. J Clin Endocrinol Metab 1992;75: 1431–1435.Google ScholarPubMed
Leese, G, Chattington, P, Fraser, W, Vora, J, Edwards, R, Williams, G.Short-term night-shift working mimics the pituitary-adrenocortical dysfunction of chronic fatigue syndrome. J Clin Endocrinol Metab 1996;81: 1867–1870.Google ScholarPubMed
Stupnicki, R, Obminski, Z.Glucocorticoid response to exercise as measured by serum and salivary cortisol. Eur J Appl Physiol 1992;65: 546–549. CrossRefGoogle ScholarPubMed
Bazelmans, E, Bleijenberg, G, van der Meer, J, Folgering, H.Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity. Psychol Med 2001;31: 107–114.CrossRefGoogle ScholarPubMed
Candy, B, Chalder, T, Cleare, AJet al. Predictors of fatigue following the onset of infectious mononucleosis. Psychol Med 2003;33: 847–855.CrossRefGoogle ScholarPubMed
De Bellis, M, Chrousos, G, Dorn, Let al. Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls. J Clin Endocrinol Metab 1994;78: 249–255.Google ScholarPubMed
Heim, C, Newport, DJ, Heit, Set al. Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. J Am Med Assoc 2000;284: 592–597. CrossRefGoogle ScholarPubMed
Wolfe, F, Smythe, H, Yunus, Met al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arth Rheumat 1990;33: 160–173. CrossRefGoogle ScholarPubMed
Wessely, S, Nimnuan, C, Sharpe, M.Functional somatic syndromes: one or many? Lancet 1999;354: 936–939.CrossRefGoogle ScholarPubMed
McCain, G, Tilbe, K.Diurnal hormone variation in fibromyalgia syndrome: a comparison with rheumatoid arthritis. J Rheumatol 1989;16(Suppl. 19):154–157. Google Scholar
Crofford, L, Pillemer, S, Kalogeras, Ket al. Hypothalamic-pituitary-adrenal axis perturbations in patients with fibromyalgia. Arth Rheumat 1994;37: 1583–1592. CrossRefGoogle ScholarPubMed
Lentjes, EG, Griep, EN, Boersma, JW, Romijn, FP, De Kloet, ER.Glucocorticoid receptors, fibromyalgia and low back pain. Psychoneuroendocrinology 1997;22: 603–614.CrossRefGoogle ScholarPubMed
van Denderen, J, Boersma, J, Zeinstra, P, Hollander, A, van Neerbos, B.Physiological effects of exhaustive physical exercise in primary fibromyalgia syndrome (PFS): Is PFS a disorder of neuroendocrine reactivity? Scand J Rheum 1992;21: 35–37.CrossRefGoogle ScholarPubMed
Kirnap, M, Colak, R, Eser, C, Ozsoy, O, Tutus, A, Kelestimur, F.A comparison between low-dose (1 microg), standard-dose (250 microg) ACTH stimulation tests and insulin tolerance test in the evaluation of hypothalamo-pituitary-adrenal axis in primary fibromyalgia syndrome. Clin Endocrinol 2001;55: 455–459. CrossRefGoogle ScholarPubMed
Adler, GK, Kinsley, BT, Hurwitz, S, Mossey, CJ, Goldenberg, DL.Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome. Am J Med 1999;106: 534–543.CrossRefGoogle ScholarPubMed
Griep, E, Boersma, J, De Kloet, R.Altered reactivity of the hypothalamic-pituitary adrenal axis in the primary fibromyalgia syndrome. J Rheumatol 1993;20: 469–474.Google ScholarPubMed
Griep, EN, Boersma, JW, Lentjes, EG, Prins, AP, van der Korst, JK, De Kloet, E.Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J Rheumatol 1998;25: 1374–1381.Google ScholarPubMed
Nathan, KI, Musselman, DL, Schatzberg, AF, Nemeroff, CB.Biology of mood disorders. In: Schatzberg, AF, Nemeroff, CB, eds. Textbook of psychopharmacology. Washington DC: American Psychiatric Press, 1995. Google Scholar
Posternak, MA, Zimmerman, M.Partial validation of the atypical features subtype of major depressive disorder. Arch General Psych 2002;59: 70–76. CrossRefGoogle ScholarPubMed
Levitan, RD, Vaccarino, FJ, Brown, GM, Kennedy, Sh.Low-dose dexamethasone challenge in women with atypical major depression: pilot study. J Psychiatr Neurosci 2002;27: 47–51. Google ScholarPubMed
Anisman, H, Ravindran, AV, Griffiths, J, Merali, Z.Endocrine and cytokine correlates of major depression and dysthymia with typical or atypical features. Mol Psychiatry 1999;4: 182–188.CrossRefGoogle ScholarPubMed
Geracioti, TD J, Loosen, PT, Gold, PW, Kling, MA.Cortisol, thyroid hormone, and mood in atypical depression: a longitudinal case study. Biol Psychiatry 1992;31: 515–519.CrossRefGoogle ScholarPubMed
Torpy, DJ, Bachmann, AW, Grice, JEet al. Familial corticosteroid-binding globulin deficiency due to a novel null mutation: association with fatigue and relative hypotension. J Clin Endocrinol Metabol 2001;86: 3692–3700. CrossRefGoogle ScholarPubMed
Fleshner, M, Deak, T, Spencer, RL, Laudenslager, ML, Watkins, LR, Maier, SF.A long term increase in basal levels of corticosterone and a decrease in corticosteroid-binding globulin after acute stressor exposure. Endocrinology 1995;136: 5336–5342.CrossRefGoogle Scholar
Schlecte, JA, Hamilton, D.The effect of glucocorticoids on corticosteroid binding globulin. Clin Endocrinol 1987;27: 197–203. CrossRefGoogle Scholar
McAllister-Williams, RH, Ferrier, IN, Young, AH.Mood and neuropsychological function in depression. the role of corticosteroids and serotonin. Psychol Med 1998;28: 573–584.CrossRefGoogle ScholarPubMed
De Kloet, E, Sybesma, H, Reul, J.Selective control by corticosterone of serotonin-1 recptors capacity in raphe-hippocampal system. Neuroendocrinology 1986;42: 513–521.CrossRefGoogle Scholar
Delbende, C, Delarue, C, Lefebvre, Het al. Glucocorticoids, transmitters and stress. Br J Psychiatry Suppl 1992;15: 24–1535.Google Scholar
Bakheit, A, Behan, P, Dinan, T, Gray, C, O'Keane, V.Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. Br Med J 1992;304: 1010–1012. CrossRefGoogle ScholarPubMed
Sharpe, M, Clements, A, Hawton, K, Young, A, Sargent, P, Cowen, P.Increased prolactin response to buspirone in chronic fatigue syndrome. J Affect Disord 1996;41: 71–76.CrossRefGoogle ScholarPubMed
Sharpe, M, Hawton, K, Clements, A, Cowen, PJ.Increased brain serotonin function in men with chronic fatigue syndrome. Br Med J 1997;315: 164–165. CrossRefGoogle ScholarPubMed
Wilson, A, Hickie, I, Hadzi-Pavlovic, Det al. What is chronic fatigue syndrome? Heterogeneity within an international multicentre study. Austr NZ J Psychiatry 2001;35: 520–527. CrossRefGoogle ScholarPubMed
Whiting, P, Bagnall, AM, Sowden, AJ, Cornell, JE, Mulrow, CD, Ramirez, G.Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. J Am Med Assoc 2001;286: 1360–1368. CrossRefGoogle ScholarPubMed
Candy, B, Chalder, T, Cleare, AJ, Wessely, S, White, PD, Hotopf, M.Recovery from infectious mononucleosis: a case for more than symptomatic therapy? A systematic review. Br J Gen Pract 2002;52: 844–851. Google Scholar
Salmon, P, Hall, GM.A theory of postoperative fatigue: an interaction of biological, psychological, and social processes. Pharmacol Biochem Behav 1997;56: 623–628.CrossRefGoogle ScholarPubMed
Loge, J, Abrahamsen, A, Ekeberg, O, Kaasa, S.Hodgkin's disease survivors more fatigued than the general population. J Clin Oncol 1999;17: 253–261.CrossRefGoogle Scholar