OBJECTIVE. To examine basal and stimulated
hypothalamic-pituitary-adrenal (HPA) axis and related hormone
levels, including adrenocorticotropin (ACTH), cortisol,
arginine vasopressin (AVP), and neuropeptide Y (NPY), in
patients with fibromyalgia (FM).
METHODS. Basal and ovine
corticotropin-releasing hormone (oCRH)-stimulated HPA axis
function were assessed in 12 patients with FM and in age- and
sex-matched normal subjects. Basal plasma AVP levels and AVP
release after postural change were assessed, and plasma NPY
levels [“colocalizes w norepinephrine and stimulated
peripherally during stress”] were measured in the same
RESULTS. Patients with FM had low 24-hour urinary
free cortisol, but normal peak [i.e., at 0800] and elevated
trough [i.e, at2000] plasma cortisol levels, compared with
normal subjects. The net integrated ACTH response to oCRH in
FM was not significantly different from that in normal
subjects, but tended toward an exaggerated response. There was
a significant decrease in net integrated cortisol response to
oCRH in FM patients, indicating adrenal hyporesponsiveness.
AVP levels were not significantly different between FM
patients and control subjects, but variability was greater
among the FM patients. Plasma NPY levels were significantly
lower in FM patients than in normal subjects.
CONCLUSION. These data support the view that HPA axis
function is perturbed in patients with FM. Further study is
required to ascertain the cause of HPA axis perturbations and
their relationship to symptoms in patients with FM.
Crofford LJ, Pillemer SR, Kalogeras KT, Cash JM, Michelson D, Kling
MA, Sternberg EM, Gold PW, Chrousos GP, Wilder RL