Whenever I exert myself (either mentally, or physically) I get severe fatigue/ crash 2 or 3 days later. Exertion always involves both cortisol and adrenaline, both products of the adrenal gland. The only symptom I have the day (or morning) after the exertion is that I wake up very early (like 5 or 4 AM). 4 AM is the time when cortisol should be LOWEST, but instead I feel a lot of adrenaline, or a cortisol SURGE. This early awakening is most likely a result of some adrenal malfunctioning. Could it be that the increase in adrenaline/ cortisol during the exertion is the cause of some sort of adrenal malfunctioning that leads to an adrenal crash 2 or 3 days after our exertion? Is it possible that CFS/ME includes some variant of cushings syndrome? If that is the case we should focus on restoring our adrenals. Would like to hear your ideas, and maybe anyone has observed reduced PEM when working on adrenals? If there was some medicine that controls cortisol/ adrenaline then theoretically this could avoid PEM. Is there something that has this effect? Could people also list whatever they found that reduced their PEM?