Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome

doi:10.1016/S0002-9343(99)00074-1

The American Journal of Medicine

Volume 106, Issue 5, May 1999, Pages 534-543

https://doi.org/10.1016/S0002-9343(99)00074-1 Get rights and content

Abstract

PURPOSE: To perform a detailed comparison of the hypothalamic-pituitary-adrenal axis and the sympathoadrenal system in women with and without fibromyalgia.

SUBJECTS AND METHODS: Fifteen premenopausal women who met the 1990 American College of Rheumatology criteria for the diagnosis of fibromyalgia and 13 healthy, premenopausal women were enrolled. We measured baseline 24-hour urinary free cortisol levels and evening and morning adrenocorticotropic hormone (ACTH) and cortisol levels, performed stepped hypoglycemic hyperinsulinemic clamp studies in which serum glucose levels were decreased from 5.0 to 2.2 mmol/L, and compared the effects of infusions of placebo and ACTH.

RESULTS: Women with fibromyalgia had normal 24-hour urinary free cortisol levels and normal diurnal patterns of ACTH and cortisol. There was a significant, approximately 30%, reduction in the ACTH and epinephrine responses to hypoglycemia in women with fibromyalgia compared with controls. Prolactin, norepinephrine, cortisol, and dehydroepiandrosterone responses to hypoglycemia were similar in the two study groups. In subjects with fibromyalgia, the epinephrine response to hypoglycemia correlated (P = 0.01) inversely with overall health status as measured by the fibromyalgia impact questionnaire. Graded ACTH infusion revealed similar increases in cortisol in women with fibromyalgia and healthy controls.

CONCLUSIONS: Patients with fibromyalgia have an impaired ability to activate the hypothalamic-pituitary portion of the hypothalamic-pituitary-adrenal axis as well as the sympathoadrenal system, leading to reduced ACTH and epinephrine responses to hypoglycemia.

Section snippets

Subjects

Fifteen premenopausal adult women who met the 1990 American College of Rheumatology criteria for the diagnosis of fibromyalgia (2) were recruited from the clinical practice of one author (DLG). The criteria require that a patient have widespread pain (axial, upper and lower body, and right- and left-sided) and must have tenderness of at least 11 of 18 specific sites. Fibromyalgia patients had no concurrent medical problems, except for 1 patient who had treated hypothyroidism, with a normal

Results

There were no significant differences in age, weight, body mass index, thyroid function tests, or endocrine history between patients with fibromyalgia and control subjects (Table 2). The mean duration of fibromyalgia was 9 ± 8 years, with a range of 2 to 26 years. Patients with fibromyalgia were more likely than control subjects to have had a psychiatric disorder as determined by the Structured Clinical Interview from DSM-III-R Table 1, Table 2, at least in part because of the exclusion of

Discussion

We found a 30% reduction in the ACTH and epinephrine responses to a stepped hypoglycemic challenge in women with fibromyalgia as compared with healthy women. Despite the reduced ACTH response, the cortisol response to hypoglycemia was normal. Furthermore, in contrast to previous hypotheses 9, 11, adrenal sensitivity to infused ACTH was normal in patients with fibromyalgia.

Under basal conditions, women with fibromyalgia had a normal diurnal pattern of cortisol-binding globulin, ACTH, and

Acknowledgements

The authors wish to thank Seymour Reichlin MD, PhD, Gordon Williams, MD, Joel Posener, MD, and Anthony Komaroff, MD, for their help and encouragement in these studies. We also wish to thank the General Clinical Research Center Core Laboratory personnel for performing the hormone assays and the nurses in the Brigham and Women’s Hospital Clinical Research Center for assistance in the performance of this study.

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^☆: Supported by Grants AR43130 and RR02635 from the National Institutes of Health, Bethesda, Maryland.

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Clinical StudiesReduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome☆

Abstract

Section snippets

Subjects

Results

Discussion

Acknowledgements

Baillieres Clin Rheumatol

Life Sci

J Biol Chem

Exp Gerontol

Trends Neurosci

Neuroscience

Eur J Pharmacol

Pain

Am J Med

Fibromyalgia syndrome

JAMA

The American College of Rheumatology 1990 criteria for the classification of fibromyalgiareport of the Multicenter Criteria Committee

Arthritis Rheum

The prevalence and characteristics of fibromyalgia in the general population

Arthritis Rheum

Muscle pathology in primary fibromyalgia syndromea light microscopic, histochemical and ultrastructural study

J Rheumatol

Lack of association between fibromyalgia syndrome and abnormalities in muscle energy metabolism

Arthritis Rheum

Corticosteroid therapy, nonendocrine disease, and corticosteroid withdrawal

Curr Ther Endocrinol Metab

Recovery of responses to ovine corticotropin-releasing hormone after withdrawal of a short course of glucocorticoids

J Clin Endocrinol Metab

Hypothalamic-pituitary-adrenal axis perturbations in patients with fibromyalgia

Arthritis Rheum

Diurnal hormone variation in fibromyalgia syndromea comparison with rheumatoid arthritis

J Rheumatol

Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome

J Rheumatol

Clinical Studies
Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome☆