title: Does hypocortisolism predict a poor response to cognitive behavioural therapy in chronic fatigue syndrome?
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).
  
  
  METHODS
  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.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
authors.forename: A D L
authors.initials: AD
authors.lastname: Roberts
authors.forename: M-L
authors.initials: ML
authors.lastname: Charler
authors.forename: A
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: S
authors.initials: S
authors.lastname: Wessely
authors.forename: T
authors.initials: T
authors.lastname: Chalder
authors.forename: A J
authors.initials: AJ
authors.lastname: Cleare
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism / Q000652:urine; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000378:metabolism* / Q000628:therapy* / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism* / Q000652:urine; D008131:London; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012463:Saliva; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone