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The growth hormone (GH)-releasing hormone-GH-insulin-like growth

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Fibromyalgia (FM) is a painful syndrome of nonarticular

origin, characterized by fatigue and widespread

musculoskeletal pain, tiredness, and sleep disturbances,

without any other objective findings on examination.

Interestingly, some of the clinical features of FM resemble

the ones described in the adult GH-deficiency syndrome.

Furthermore, insulin-like growth factor (IGF)-1 levels are

frequently reduced in patients with FM. To gain further

insight into the mechanisms leading to dysregulation of the

GH-IGF-1 axis in these patients, we assessed 24-h spontaneous

GH secretion, GH responses to GHRH, and IGF-1 and IGF binding

protein (BP)-3 levels before and after 4 days treatment with

human (h)GH. We found that, in comparison with controls,

patients with FM exhibited a marked decrease in spontaneous GH

secretion as assessed by mean GH secretion (2.5 +/- 0.4

microg/L in controls vs. 1.2 +/- 0.1 microg/L in FM, P <

0.05), pulse height (4.7 +/- 0.8 microg/L in controls vs. 2.5

+/- 0.3 microg/L in FM, P < 0.05), and pulse area (4.7 +/- 1

min/mg x L in controls vs. 2.3 +/- 0.3 min/mg x L in FM, P <

0.05). In contrast, GH responses to GHRH (100 microg, i.v.)

were similar in controls (mean peak, 13.5 +/- 2.5 microg/L)

and in patients with FM (12.2 +/- 3 microg/L). Finally,

treatment with hGH (2 IU, s.c. daily), over 4 days, led to a

clear-cut increase in plasma IGF-1 and IGFBP-3 levels in

patients with FM. In conclusion, our data show that patients

with FM exhibited a marked decrease in spontaneous GH

secretion, but normal pituitary responsiveness to exogenously

administered GHRH, thus suggesting the existence of an

alteration at the hypothalamic level in the neuroendocrine

control of GH in these patients. Furthermore, our finding of

increased IGF-1 and IGFBP-3 levels after GH treatment, over 4

days, opens up the possibility of testing the therapeutic

potential of hGH in patients with FM.

Leal-Cerro A, Povedano J, Astorga R, Gonzalez M, Silva H,

Garcia-Pesquera F, Casanueva FF, Dieguez C

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