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Horm Behav. 2018 Jul;103:1-6. doi: 10.1016/j.yhbeh.2018.05.016. Epub 2018 May 29.

Hair and salivary cortisol in a cohort of women with chronic fatigue syndrome.

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Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address:
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Psychology, University of Vienna, Vienna, Austria.
The Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands.
Department of Medical Psychology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands.


Hypocortisolism has been found in CFS patients in blood, urine, and saliva. It is unclear if hypocortisolism can also be demonstrated using long-term cortisol measurements, such as cortisol in hair. In addition, the interaction between the HPA axis and the immune system, both expected to play an important role in CFS, is unclear. The objective of the current study was to compare hair and salivary cortisol concentrations in a cohort of female CFS patients to those in healthy controls, and to test the effect of an interleukin-1 receptor antagonist (anakinra) on the HPA axis. Salivary cortisol concentrations of 107 CFS patients were compared to 59 healthy controls, with CFS patients showing a decreased cortisol awakening response (4.2 nmol/L ± 5.4 vs 6.1 nmol/L ± 6.3, p = 0.036). Total cortisol output during the day did not differ significantly in saliva, but there was a trend to lower hair cortisol in a subset of 46 patients compared to 46 controls (3.8 pg/mg ± 2.1 vs 4.3 pg/mg ± 1.8, p = 0.062). After four weeks of treatment with either daily anakinra (100 mg/day) or placebo, there was a slight decrease of hair cortisol concentrations in the anakinra group compared to an increase in the placebo group (p = 0.022). This study confirms the altered dynamics of the HPA axis in a group of CFS patients, and for the first time shows that this might also be present for long-term cortisol measures.


Chronic fatigue syndrome; Hair cortisol; Salivary cortisol

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