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Salivary cortisol response to awakening in chronic fatigue syndrome

Section of General Hospital Psychiatry, Division of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and Dentistry, London

Simon Wessely, FRCPsych and Trudie Chalder, PhD

Section of General Hospital Psychiatry, Division of Psychological Medicine, Guy's, Kings and St Thomas' School of Medicine and Dentistry, and Chronic Fatigue Syndrome Unit, King's College Hospital, London

Andrew Papadopoulos, CChem

Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, Institute of Psychiatry, and Affective Disorders Unit, Maudsley Hospital, London

Anthony J. Cleare, MRCPsych

Section of General Hospital Psychiatry, Division of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and Dentistry, Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, Institute of Psychiatry, Chronic Fatigue Syndrome Unit, King's College Hospital and Affective Disorders Unit, Maudsley Hospital, London

Correspondence: Dr Anthony Cleare, Department of Psychological Medicine, King's College School of Medicine and Dentistry and the Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. Tel: 020 7848 5130; fax: 020 7848 5408; e-mail: a.cleare{at}iop.kcl.ac.uk

Declaration of interest None.

Funding detailed in Acknowledgements.

Background There 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.

Aims To assess the HPA axis using the salivary cortisol response to awakening in CFS.

Method We measured salivary cortisol upon awakening and 10, 20, 30 and 60 min afterwardsin 56 patients with CFS and 35 healthy volunteers.

Results Patients had a lower cortisol response to awakening, measured by the area under the curve.

Conclusions This naturalistic test of the HPA axis response to stress showed impaired HPA axis function in CFS.

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