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These hormonal elevations in response to RE take place in a unique physiological environment, whereby acute elevations in circulating blood hormone concentrations, resulting from a combination of either e.g., increased secretion, reduced hepatic clearance, reduced plasma volume or reduced degradation ratesinteract with receptors on the target tissue cell membranes or with nuclear/cytoplasmic receptors located within the target tissue (e.g., steroid receptors)

Taken together, the above findings are supportive of the hypotheses of increased oxidative stress, inflammation and impaired oxidative energy metabolism in ME/CFS