Abstract

Background. There is evidence that patients with chronic fatigue syndrome (CFS) have mild hypocortisolism. The
clinical significance of this is unclear. We aimed to determine whether hypocortisolism exerted any effect on the
response of CFS to cognitive behavioural therapy (CBT).
Method. We measured 24-h urinary free cortisol (UFC) in 84 patients with Centers for Disease Control and
Prevention (CDC)-defined CFS (of whom 64 were free from psychotropic medication) who then received CBT in a
specialist, tertiary out-patient clinic as part of their usual clinical care. We also measured salivary cortisol output
from 0800 to 2000 h in a subsample of 56 psychotropic medication-free patients.
Results. Overall, 39% of patients responded to CBT after 6 months of treatment. Lower 24-h UFC output was
associated with a poorer response to CBT but only in psychotropic medication-free patients. A flattened diurnal
profile of salivary cortisol was also associated with a poor response to CBT.
Conclusions. Low cortisol is of clinical relevance in CFS, as it is associated with a poorer response to CBT.
Hypocortisolism could be one of several maintaining factors that interact in the persistence of CFS.