Cortisol levels in ME/CFS

I did a salivary cortisol test (four samples throughout the day) quite a long time ago and my cortisol was well over the range in 3 out of the 4 samples, and 90% of the way through the range for the sample that wasn't over the range.

Much more recently I had my first ever blood cortisol test done at around 8.30am - 9am and that was over the range too.

I have read that very high stress can cause high cortisol and if the high cortisol lasts long enough then it becomes the patient's new "normal". If that is true then I wonder what causes cortisol to become low.
 
Post-COVID-19 condition in prospective inpatient and outpatient cohorts (2025, Scientific Reports)
PCC patients were manually distributed into three symptom clusters corresponding to their most dominant self-reported symptoms according to Global Burden of Disease Long COVID Collaborators guidelines (supplementary information).

Shortly, persistent fatigue with myalgia or mood swings (cluster 1) included bodily pain (myalgia), weakened muscular strength, numbness and tingling, fatigue, and mood disturbances.

Cognitive problems (cluster 2) included attention deficit and cognitive difficulties, and

ongoing respiratory problems (cluster 3) included exertional and resting dyspnea, persistent cough, and thoracic pain.
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During the 24-month follow-up, cluster 2 patients had lower cortisol levels than those belonging to clusters 1 and 3 (Supplementary Fig. 10 C). Twelve months post-infection, the difference was statistically significant (179 vs. 290 nmol/l, p = 0.031, and 179 vs. 351 nmol/l, p = 0.054). However, while the trend was similar throughout the follow-up, the differences did not reach statistical significance at any other time point, likely due to the small subgroup sizes.
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Between all long COVID (PCC) and healthy, it seems cortisol was only lower at the acute phase. Figure 4C:
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The overall cortisol levels were significantly lower in the acute phase – especially among inpatients with a severe disease. This can result from treatment with corticosteroids, suppressing endogenous cortisol production. However, we did not collect the samples uniformly at the same time of the day, resulting in increased variation in cortisol levels.
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Post-COVID-19 condition in prospective inpatient and outpatient cohorts (2025, Nature Scientific Reports)

In the whole group, spirometry results, orthostatic hypotension, or levels of soluble suppression of tumorigenicity 2, interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), or cortisol had no association with PCC. However, using symptom clusters, patients with cognitive problems had lower cortisol levels, while patients with ongoing respiratory or myalgic symptoms had higher levels of IL-6 and hs-CRP.
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