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Neurohormonal perturbations in fibromyalgia
L J Crofford1, N C Engleberg, M A Demitrack
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA.
Bailliere'S Clinical Rheumatology
|May 1, 1996
Summary
Fibromyalgia (FM) is linked to stress response system disturbances, including the HPA axis and sympathetic nervous system. Neuroendocrine abnormalities may explain FM symptoms like pain and fatigue.
Area of Science:
- Neuroendocrinology
- Stress-associated syndromes
Background:
- Fibromyalgia (FM) often follows stress and symptoms worsen with stress.
- Patients with FM show dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system.
Purpose of the Study:
- To explore the neuroendocrine abnormalities in fibromyalgia patients.
- To investigate the relationship between these abnormalities and FM symptoms.
Main Methods:
- Assessed HPA axis function through responses to corticotropin-releasing hormone (CRH) and insulin-induced hypoglycemia.
- Measured 24-hour urine-free cortisol and plasma NPY levels.
- Examined autonomic nervous system activity and other neuroendocrine systems.
Main Results:
- FM patients exhibit low basal cortisol levels and blunted cortisol responses to ACTH and exercise.
- Exaggerated ACTH response to CRH or insulin-induced hypoglycemia was observed.
- Low plasma NPY suggests disturbed sympathetic nervous system activity.
- Abnormalities in serotonergic activity and the growth hormone axis were noted.
Conclusions:
- Neuroendocrine perturbations, including HPA axis and sympathetic nervous system dysfunction, are characteristic of fibromyalgia.
- These abnormalities may underlie key FM symptoms such as widespread pain and fatigue.
- Understanding these links could lead to improved fibromyalgia treatment strategies.