Trial Report Lower hair cortisol concentration in adolescent and young adult patients with ME/CFS & Q-Fever Fatigue Syndrome compared to controls,'24,Vroegindeweij

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Anouk Vroegindeweij, Niels Eijkelkamp, Sjoerd A.A. van den Berg, Elise M. van de Putte, Nico M. Wulffraat, Joost F. Swart and Sanne L. Nijhof, Lower hair cortisol concentration in adolescent and young adult patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Q-Fever Fatigue Syndrome compared to controls, Psychoneuroendocrinology, (2024) doi:https://doi.org/10.1016/j.psyneuen.2024.10711

Lower hair cortisol concentration in adolescent and young adult patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Q-Fever Fatigue Syndrome compared to controls

Anouk Vroegindeweij a b, Niels Eijkelkamp c, Sjoerd A.A. van den Berg d e, Elise M. van de Putte b, Nico M. Wulffraat a, Joost F. Swart a f 1, Sanne L. Nijhof b

1 a Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands b Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands c Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands d Department of Clinical Chemistry, Erasmus Medical Center, University Medical Centre Rotterdam, the Netherlands e Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, 3015 GD Rotterdam, the Netherlands f Faculty of Medicine, Utrecht University, Utrecht, the Netherlands

Received 19 April 2024, Revised 10 June 2024, Accepted 27 June 2024, Available online 28 June 2024.

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Show less Add to Mendeley Share Cite https://doi.org/10.1016/j.psyneuen.2024.107117 Get rights and content Under a Creative Commons license open access Highlights • Hair cortisol concentration (HCC) was lower in patients with ME/CFS and QFS;

• Overall, HCC had a negative association with chronic fatigue syndrome symptoms;

• Except in patients with QFS, in which HCC increased with the presence of symptoms;

• HCC increased significantly during the RCT, regardless of fatigue improvement.

Abstract

Background

In patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), momentary cortisol concentrations in blood, urine, and saliva are lower compared to healthy controls. Long-term cortisol concentration can be assessed through hair, but it is unclear whether these concentrations are also lower. Additionally, it is unknown if lower cortisol extends to other patients suffering from persistent fatigue and how hair cortisol concentration (HCC) relates to fatigue levels. Therefore, this study examines HCC in fatigued patients with ME/CFS, Q fever Fatigue Syndrome (QFS), Post-COVID-19 condition (PCC), and Juvenile Idiopathic Arthritis (JIA).

Methods

Adolescent and young adult patients with ME/CFS (n=12), QFS (n=20), PCC (n=8), JIA (n=19), and controls (n=57) were included. Patients participated in a randomized cross-over trial (RCT) targeting fatigue through lifestyle and dietary self-management strategies. HCC was measured pre-post RCT in patients and once in controls, quantified using a LC-MS/MS-based method. Fatigue severity was measured with the Checklist Individual Strength-8. HCC was compared between groups with ANOVAs. Relations between HCC, fatigue severity, and other variables were investigated using linear regression analyses.

Results

The ME/CFS (p=.009) and QFS (p=.047) groups had lower HCC compared to controls. Overall, HCC was negatively associated with the presence of symptoms related to chronic fatigue syndromes (e.g., sleeping issues, often feeling tired, trouble thinking clearly; β=-0.018, p=.035), except in the QFS group (β=.063, p<.001). Baseline HCC did not predict fatigue improvement during the RCT (p=.449), and HCC increased during the trial (Mdif=.076, p=.021) regardless of clinically relevant fatigue improvement (p=.658).

Conclusion

Lower cortisol concentration can also be observed in the long-term. Lower HCC is not limited to ME/CFS, as it was also observed in QFS. The role of cortisol may differ between these diagnoses and appears to be unrelated to fatigue levels.