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Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia (FM)

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By Bennett RM, Cook DM, Clark SR, Burckhardt CS, Campbell SM • www.ProHealth.com • July 5, 1997


OBJECTIVE: To investigate the serum levels of insulin-like growth
factor-I (IGF-I) in patients with fibromyalgia (FM) compared
to healthy controls and patients with other rheumatic
diseases, and to explore possible etiologic mechanisms of low
IGF-I levels in patients with FM.

METHODS: Five hundred
patients with FM and 152 controls (74 healthy blood donors, 26
myofascial pain patients and 52 patients with other rheumatic
diseases) were studied. All had measurements of acid extracted
serum IGF-I. A subset of 90 patients with FM were evaluated
for clinical features that might explain low IGF-I levels.
Twenty-five patients with FM underwent growth hormone (GH)
provocation testing with l-dopa and clonidine.

RESULTS: The
mean serum IGF-I level in patients with FM was 138 +/- 56
ng/ml and in controls 215 +/- 86 ng/ml (p = 0.00000000001).
Low levels of IGF-I were not due to depression, tricyclic
medications, nonsteroidal antiinflammatory drugs, poor aerobic
conditioning, obesity, or pain level. Patients with focal
myofascial pain syndromes had normal IGF-I levels (236 +/-
68), as did most patients with other rheumatic disorders,
unless they had concomitant FM. Patients with FM with
initially normal levels often had a rapid decline of IGF-I
over 1 to 2 years. Most patients with FM with low IGF-I levels
failed to secrete GH after stimulation with clonidine and
l-dopa.

CONCLUSION: Many, but not all, patients with FM have
low levels of IGF-I that cannot be explained by clinical
associations. These results suggest that low IGF-I levels in
patients with FM are a secondary phenomenon due to
hypothalamic-pituitary-GH axis dysfunction.




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