Hypothalamic-pituitary-adrenal axis perturbations in patients with fibromyalgia (FM)

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

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