Department of Psychological Medicine, Institute of Psychiatry, Box P074, 103 Denmark Hill, London SE5 8AZ, UK.
Nat Rev Endocrinol. 2011 Sep 27;8(1):22-32. doi: 10.1038/nrendo.2011.153.
The weight of current evidence supports the presence of the following factors related to hypothalamic-pituitary-adrenal (HPA) axis dysfunction in patients with chronic fatigue syndrome (CFS): mild hypocortisolism; attenuated diurnal variation of cortisol; enhanced negative feedback to the HPA axis; and blunted HPA axis responsiveness. Furthermore, HPA axis changes seem clinically relevant, as they are associated with worse symptoms and/or disability and with poorer outcomes to standard treatments for CFS. Regarding etiology, women with CFS are more likely to have reduced cortisol levels. Studies published in the past 8 years provide further support for a multifactorial model in which several factors interact to moderate HPA axis changes. In particular, low activity levels, depression and early-life stress appear to reduce cortisol levels, whereas the use of psychotropic medication can increase cortisol. Addressing these factors-for example, with cognitive behavioral therapy-can increase cortisol levels and is probably the first-line approach for correcting HPA axis dysfunction at present, as steroid replacement is not recommended. Given what is now a fairly consistent pattern of findings for the type of HPA axis changes found in CFS, we recommend that future work focuses on improving our understanding of the cause and relevance of these observed changes.
目前的证据表明，慢性疲劳综合征（CFS）患者的下丘脑-垂体-肾上腺（HPA）轴功能障碍与以下因素有关：轻度皮质醇减少；皮质醇昼夜变化减弱；HPA 轴的负反馈增强；HPA 轴反应迟钝。此外，HPA 轴的变化似乎与临床症状有关，因为它们与更严重的症状和/或残疾以及对 CFS 的标准治疗的效果较差有关。关于病因，CFS 女性更有可能出现皮质醇水平降低的情况。过去 8 年发表的研究进一步支持了一种多因素模型，其中几个因素相互作用，调节 HPA 轴的变化。特别是，活动水平低、抑郁和早年生活压力似乎会降低皮质醇水平，而使用精神药物会增加皮质醇水平。解决这些因素——例如，采用认知行为疗法——可以增加皮质醇水平，目前可能是纠正 HPA 轴功能障碍的首选方法，因为不建议使用类固醇替代疗法。鉴于目前发现的 CFS 中 HPA 轴变化的类型存在相当一致的模式，我们建议未来的研究工作重点是提高我们对这些观察到的变化的原因和相关性的理解。
