CRH and myalgic encephalomeyelitis/chronic fatigue syndrome: There is also some evidence of an association of HPA axis dysregulation with symptom severity and poorer prognosis [15, 39] but only speculation about the mechanism through which HPA axis abnormalities may result in the symptoms of CFS; glucose supply [40], hypotension with associated reduced cerebral perfusion [41], and CRH-induced appetite and sleep disturbance have been considered [16].