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Research on Fibromyalgia
Reduced hypothalamic-pituitary and sympathoadrenal
responses to hypoglycemia in women with fibromyalgia syndrome.
| AUTHORS:
| Adler GK; Kinsley BT; Hurwitz S;
Mossey CJ; Goldenberg DL
| AUTHOR AFFILIATION:
| Department of Medicine, Brigham
& Women's Hospital, Harvard Medical School, Boston, Massachusetts
02115, USA.
| SOURCE:
| Am J Med 1999 May;106(5):534-43
| CITATION IDS:
| PMID: 10335725 UI: 99266756
| 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.
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