RefDoc
Haut

Faire une nouvelle recherche
Make a new search
Lancer la recherche


Titre du document / Document title

Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain

Auteur(s) / Author(s)

GRIEP E. N. (1 2) ; BOERSMA J. W. ; LENTJES E. G. W. M. (3) ; PRINS A. P. A. (1) ; VAN DER KORST J. K. (4) ; DE KLOET E. R. (4) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Research Department, Jan van Breemen Institute, Amsterdam, ETATS-UNIS
(2) Department of Rheumatology, Medical Center, Leeuwarden, PAYS-BAS
(3) Department of Clinical Chemistry Academic Hospital, Leiden, PAYS-BAS
(4) Division of Medical Pharmacology, Leiden/Amsterdam Center for Drug Research, University of Leiden, Leiden, PAYS-BAS

Résumé / Abstract

Objective, We suggested fibromyalgia (FM) is a disorder associated with an altered functioning of the stress-response system. This was concluded from hyperreactive pituitary adrenocorticotropic hormone (ACTH) release in response to corticotropin-releasing hormone (CRH) and to insulin induced hypoglycemia in patients with FM. In this study, we tested the validity and specificity of this observation compared to another painful condition, low back pain. Methods. We recruited 40 patients with primary FM (F:M 36:4), 28 patients (25:3) with chronic non-inflammatory low back pain (LBP), and 14 (12:2) healthy, sedentary controls. A standard 100 μg CRH challenge test was performed with measurement of ACTH and cortisol levels at 9 time points. They were also subjected to an overnight dexamethasone suppression test, followed by injection of synthetic ACTH1-24. At 9 AM, the patients divided in 2 groups, received either 0.025 or 0.100 μg ACTH/kg body weight to test for adrenocortical sensitivity. Basal adrenocortical function was assessed mainly by measurement of 24 h urinary excretion of free cortisol. Results. Compared to the controls, the patients with FM displayed a hyperreactive ACTH release in response to CRH challenge (ANOVA interaction effect p = 0.001). The mean ACTH response of the patients with low back pain appeared enhanced also, but to a significantly lesser extent (p = 0.02 at maximum level) than observed in the patients with FM. The cortisol response was the same in the 3 groups. Following dexamethasone intake there were 2 and 4 nonsuppressors in the FM and LBP groups. respectively. The very low and low dose of exogenous ACTH1-24 evoked a dose and time dependent cortisol response, which, however, was not significantly different between the 3 groups. The 24 h urinary free cortisol levels were significantly lower (p = 0.02) than controls in both patient groups; patients with FM also displayed significantly lower (p < 0.05) basal total plasma cortisol than controls. Conclusion. The present data validate and substantiate our preliminary evidence for a dysregulation of the HPA axis in patients with FM, marked by mild hypocortisolemia, hyperreactivity of pituitary ACTH release to CRH, and glucocorticoid feedback resistance. Patients with LBP also display hypocortisolemia, but only a tendency toward the disrupted HPA features observed in the patients with FM. We propose that a reduced containment of the stress-response system by corticosteroid hormones is associated with the symptoms of FM.

Revue / Journal Title

Journal of rheumatology    ISSN  0315-162X   CODEN JRHUA9 

Source / Source

1998, vol. 25, no7, pp. 1374-1381 (51 ref.)

Langue / Language

Anglais

Editeur / Publisher

Journal of Rheumatology Publishing, Toronto, ON, CANADA  (1974) (Revue)

Mots-clés anglais / English Keywords

Fibromyalgia

;

Human

;

Neuroendocrinology

;

Low back pain

;

Exploration

;

Hormonal regulation

;

Hypothalamohypophysoadrenal axis

;

Symptomatology

;

Pathophysiology

;

Hydrocortisone

;

ACTH

;

Pain

;

Corticosteroid

;

Diseases of the osteoarticular system

;

Striated muscle disease

;

Spine disease

;

Rachialgia

;

Adenohypophyseal hormone

;

Peptide hormone

;

Mots-clés français / French Keywords

Fibromyalgie

;

Homme

;

Neuroendocrinologie

;

Lombalgie

;

Exploration

;

Régulation hormonale

;

Système hypothalamohypophysosurrénalien

;

Symptomatologie

;

Physiopathologie

;

Hydrocortisone

;

ACTH

;

Douleur

;

Corticostéroïde

;

Système ostéoarticulaire pathologie

;

Muscle strié pathologie

;

Rachis pathologie

;

Rachialgie

;

Hormone adénohypophysaire

;

Hormone peptide

;

Mots-clés espagnols / Spanish Keywords

Fibromialgia

;

Hombre

;

Neuroendocrinología

;

Lumbalgia

;

Exploración

;

Regulación hormonal

;

Sistema hipotalamohipofisosuprarrenal

;

Sintomatología

;

Fisiopatología

;

Hidrocortisona

;

ACTH

;

Dolor

;

Corticoesteroide

;

Sistema osteoarticular patología

;

Músculo estriado patología

;

Raquis patología

;

Raquialgia

;

Hormona adenohipofisaria

;

Hormona péptido

;

Localisation / Location

INIST-CNRS, Cote INIST : 16024, 35400007243026.0220

Nº notice refdoc (ud4) : 2337458



Faire une nouvelle recherche
Make a new search
Lancer la recherche
Bas