Journal: Seminars in Arthritis and Rheumatism
(2007 Jan 12). Published online 16 January 2007.
Authors and affiliation: Kim D. Jones, Parimal Deodhar, Ashley Lorentzen, Robert M. Bennett, Atul A. Deodhar. Oregon Health & Science University School of Nursing and School of Medicine (Division of Arthritis & Rheumatic Diseases), Portland.
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Objective: Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, fatigue, disrupted sleep, depression, and physical deconditioning. In this article, we review the literature on the normal activity of the hypothalamic-pituitary-growth hormone-insulin-like growth factor-1 (HP-GH-IGF-1) axis and its perturbations in FM subjects.
Methods: Studies included in this review were accessed through an English language search of Cochrane Collaboration Reviews. Keyword MeSH terms included “fibromyalgia,” “growth hormone” (GH), or “insulin-like growth factor-1” (IGF-1).
Results: Twenty-six studies enrolling 2006 subjects were reviewed. Overall, low levels of IGF-1 were found in a subgroup of subjects. Growth hormone stimulation tests often revealed a suboptimal response, which did not always correlate with IGF-1 levels. No consistent defects in pituitary function were found. Of the 3 randomized placebo controlled studies, only 9 months of daily injectable recombinant GH reduced FM symptoms and normalized IGF-1.
Conclusions: These studies suggest that pituitary function is normal in Fibromyalgia and that reported changes in the HP-GH-IGF-1 axis are most likely hypothalamic in origin. The therapeutic efficacy of supplemental GH therapy in FM requires further study before any solid recommendations can be made.
Keywords: Fibromyalgia, growth hormone (GH), insulin-like growth factor-1 (IGF-1), somatostatin, growth hormone releasing hormone (GHRH), hypothalamus, pituitary