This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gaab, J. Articles by Ehlert, U. Search for Related Content PubMed PubMed Citation Articles by Gaab, J. Articles by Ehlert, U. Related Collections Endocrinology Sleep and Biological Rhythms

Low-Dose Dexamethasone Suppression Test in Chronic Fatigue Syndrome and Health

From the Center for Psychobiological and Psychosomatic Research, University of Trier, Trier, Germany.

Address reprint requests to: Jens Gaab, PhD, Institute of Psychology, Clinical Psychology II, University of Zürich, Zürichbergstr. 43, CH-8044 Zürich, Switzerland. Email: jgaab{at}klipsy.unizh.ch

OBJECTIVE: Subtle dysregulations of the hypothalamus-pituitary-adrenal axis in chronic fatigue syndrome have been described. The aim of this study was to examine the negative feedback regulations of the hypothalamus-pituitary-adrenal axis in chronic fatigue syndrome.

METHODS: In 21 patients with chronic fatigue syndrome and 21 healthy control subjects, awakening and circadian salivary free cortisol profiles were assessed over 2 consecutive days and compared with awakening and circadian salivary free cortisol profiles after administration of 0.5 mg of dexamethasone at 11:00 PM the previous day.

RESULTS: Patients with chronic fatigue syndrome had normal salivary free cortisol profiles but showed enhanced and prolonged suppression of salivary free cortisol after the administration of 0.5 mg of dexamethasone in comparison to the control subjects.

CONCLUSIONS: Enhanced negative feedback of the hypothalamus-pituitary-adrenal axis could be a plausible explanation for the previously described alterations in hypothalamus-pituitary-adrenal axis functioning in chronic fatigue syndrome. Because similar changes have been described in stress-related disorders, a putative role of stress in the pathogenesis of the enhanced feedback is possible.

Key Words: chronic fatigue syndrome, • HPA axis, • salivary cortisol, • dexamethasone.

Abbreviations: AUC = area under curve;; CFS = chronic fatigue syndrome;; CRH = corticotropin-releasing hormone;; HPA = hypothalamus-pituitary-adrenal (axis);; PTSD = posttraumatic stress disorder;; SEM = standard error of the mean;; VAS = visual analog scale.

This article has been cited by other articles:

				C. Heim, U. M. Nater, E. Maloney, R. Boneva, J. F. Jones, and W. C. Reeves Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction Arch Gen Psychiatry, January 1, 2009; 66(1): 72 - 80. [Abstract] [Full Text] [PDF]

				F. Van Den Eede and G. Moorkens HPA-Axis Dysfunction in Chronic Fatigue Syndrome: Clinical Implications Psychosomatics, September 1, 2008; 49(5): 450 - 450. [Full Text] [PDF]

				U. M. Nater, L. S. Youngblood, J. F. Jones, E. R. Unger, A. H. Miller, W. C. Reeves, and C. Heim Alterations in Diurnal Salivary Cortisol Rhythm in a Population-Based Sample of Cases With Chronic Fatigue Syndrome Psychosom Med, April 1, 2008; 70(3): 298 - 305. [Abstract] [Full Text] [PDF]

				U. M. Nater, E. Maloney, R. S. Boneva, B. M. Gurbaxani, J.-M. Lin, J. F. Jones, W. C. Reeves, and C. Heim Attenuated Morning Salivary Cortisol Concentrations in a Population-Based Study of Persons with Chronic Fatigue Syndrome and Well Controls J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 703 - 709. [Abstract] [Full Text] [PDF]

				K. Wingenfeld, C. Heim, I. Schmidt, D. Wagner, G. Meinlschmidt, and D. H. Hellhammer HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in Fibromyalgia Syndrome and Chronic Pelvic Pain Psychosom Med, January 1, 2008; 70(1): 65 - 72. [Abstract] [Full Text] [PDF]

				W. K. Jerjes, N. F. Taylor, T. J. Peters, S. Wessely, and A. J. Cleare Urinary Cortisol and Cortisol Metabolite Excretion in Chronic Fatigue Syndrome Psychosom Med, July 1, 2006; 68(4): 578 - 582. [Abstract] [Full Text] [PDF]

				A. A.-B. Badawy, C. J. Morgan, M. B. Llewelyn, S. R.J. Albuquerque, and A. Farmer Heterogeneity of serum tryptophan concentration and availability to the brain in patients with the chronic fatigue syndrome J Psychopharmacol, July 1, 2005; 19(4): 385 - 391. [Abstract] [PDF]

				A. D. L. Roberts, S. Wessely, T. Chalder, A. Papadopoulos, and A. J. Cleare Salivary cortisol response to awakening in chronic fatigue syndrome The British Journal of Psychiatry, February 2, 2004; 184(2): 136 - 141. [Abstract] [Full Text] [PDF]

				J. Gaab, D. Huster, R. Peisen, V. Engert, V. Heitz, T. Schad, Th. Schurmeyer, and U. Ehlert Assessment of Cortisol Response With Low-Dose and High-Dose ACTH in Patients With Chronic Fatigue Syndrome and Healthy Comparison Subjects Psychosomatics, April 1, 2003; 44(2): 113 - 119. [Abstract] [Full Text] [PDF]

				A. J. Cleare The Neuroendocrinology of Chronic Fatigue Syndrome Endocr. Rev., April 1, 2003; 24(2): 236 - 252. [Abstract] [Full Text] [PDF]

				J. Gaab, D. Huster, R. Peisen, V. Engert, V. Heitz, T. Schad, T. H. Schurmeyer, and U. Ehlert Hypothalamic-Pituitary-Adrenal Axis Reactivity in Chronic Fatigue Syndrome and Health Under Psychological, Physiological, and Pharmacological Stimulation Psychosom Med, November 1, 2002; 64(6): 951 - 962. [Abstract] [Full Text] [PDF]