title: Neuroendocrine and immune contributors to fatigue.
abstract: Central fatigue, a persistent and subjective sense of tiredness, generally correlates poorly with traditional markers of disease. It is frequently associated with psychosocial factors, such as depression, sleep disorder, anxiety, and coping style, which suggest that dysregulation of the body's stress systems may serve as an underlying mechanism in the maintenance of chronic fatigue (CF). This article addresses the endocrine, neural, and immune factors that contribute to fatigue and describes research regarding the role of these factors in chronic fatigue syndrome as a model for addressing the biology of CF. In general, hypoactivity of the hypothalamic-pituitary-adrenal axis, autonomic nervous system alterations characterized by sympathetic overactivity and low vagal tone, as well as immune abnormalities, may contribute to the expression of CF. Noninvasive methods for evaluating endocrine, neural, and immune function are also discussed. Simultaneous evaluation of neuroendocrine and immune systems with noninvasive techniques will help elucidate the underlying interactions of these systems, their role in disease susceptibility, and progression of stress-related disorders.
authors.affiliation: Section on Neuroendocrine Immunology and Behavior, National Institute of Mental Health, National Institutes of Health, Rockville, MD(dagger).
authors.forename: Marni N
authors.initials: MN
authors.lastname: Silverman
authors.forename: Christine M
authors.initials: CM
authors.lastname: Heim
authors.forename: Urs M
authors.initials: UM
authors.lastname: Nater
authors.forename: Andrea H
authors.initials: AH
authors.lastname: Marques
authors.forename: Esther M
authors.initials: EM
authors.lastname: Sternberg
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D002908:Chronic Disease; D004198:Disease Susceptibility; D005221:Fatigue / Q000276:immunology / Q000503:physiopathology*; D015673:Fatigue Syndrome, Chronic / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007249:Inflammation / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012463:Saliva / Q000378:metabolism; D000516:alpha-Amylases / Q000378:metabolism
chemical_list: D000516:alpha-Amylases; D006854:Hydrocortisone