Patients with Fibromyalgia Have a Weaker Adrenal Response to Stress Than Those with Chronic Pelvic Pain

The control centers in the brain tell the adrenal glands when to make more of the stress hormones in response to stress. Those with Fibromyalgia have a weaker adrenal response to stress than those with chronic pelvic pain alone. This is simply one of many studies showing weak adrenal response to stress in CFS/FMS. Research and our clinical experience has shown that adrenal support with natural products (e.g., an herbal supplement that supports adrenal function) and prescription ultra low dose cortisol can be both safe and very helpful. For a review article on adrenal issues in CFS/FMS, see The Adrenal Gland.

Psychosom Med 2007, doi:10.1097/PSY.0b013e31815ff3ce

HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in Fibromyalgia Syndrome and Chronic Pelvic Pain

Address correspondence and reprint requests to: Katja Wingenfeld, PhD, E-mail: katja.wingenfeld@evkb.de.

Abstract

Objective: Chronic pelvic pain (CPP) and fibromyalgia syndrome (FMS) have been associated with hypothalamic-pituitary-adrenal (HPA) axis alterations, i.e., mild hypocortisolism and enhanced feedback sensitivity. We tested the hypothesis of reduced cortisol release in response to a psychosocial stressor and pharmacological stimulation. Furthermore, glucocorticoid (GC) sensitivity was evaluated.

Methods: Plasma total and salivary-free cortisol concentrations were measured in response to a standardized social laboratory stressor, the Trier Social Stress Test, and to adrenocorticotropin (ACTH)1-24 stimulation. In the Trier Social Stress Test, we additionally measured ACTH. GC sensitivity was measured by dexamethasone inhibition of lipopolysaccharide-induced interleukin-6 and tumor necrosis factor-alpha production in whole blood.

Results: There were no HPA axis alterations in women with CPP (N = 18) in these tests. Patients with FMS (N = 17) showed lower total cortisol release in response to the social stressor and exogenous ACTH, but normal free cortisol and ACTH levels compared with controls (N = 24). GC sensitivity was similar in all groups.

Conclusions: Our results suggest normal HPA responses to stress and ACTH stimulation in patients with CPP but reduced adrenal reactivity in patients with FMS, namely in total cortisol release. Free cortisol on the other hand was unaltered, possibly reflecting an adaptation to reduced circulating total cortisol.