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Evidence for & pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia (FM) & Chronic Fatigue Syndrome (CFS)

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Chronic fatigue syndrome (CFS) is characterized by profound
fatigue and an array of diffuse somatic symptoms. Our group
has established that impaired activation of the
hypothalamic-pituitary-adrenal (HPA) axis is an essential
neuroendocrine feature of this condition. The relevance of
this finding to the pathophysiology of CFS is supported by the
observation that the onset and course of this illness is
excerbated by physical and emotional stressors. It is also
notable that this HPA dysregulation differs from that seen in
melancholic depression, but shares features with other
clinical syndromes (e.g., fibromyalgia). How the HPA axis
dysfunction develops is unclear, though recent work suggests
disturbances in serotonergic neurotransmission and alterations
in the activity of AVP, an important co-secretagogue that,
along with CRH, influences HPA axis function. In order to
provide a more refined view of the nature of the HPA
dusturbance in patients with CFS, we have studied the
detailed, pulsatile characteristics of the HPA axis in a group
of patients meeting the 1994 CDC case criteria for CFS.

Results of that work are consistent with the view that
patients with CFS have a reduction of HPA axis activity due,
in part, to impaired central nervous system drive. These
observations provide an important clue to the development of
more effective treatment to this disabling condition.

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