Research: WINGENFELD and colleagues,

Listed in Issue 145

Abstract

WINGENFELD and colleagues, Department of Psychobiology, University of Trier, Trier, Germany, introduce the low-dose dexamethosone suppression test in fibromyalgia.

Background

Fibromyalgia syndrome has been associated with decreased cortisol secretion. Patients with posttraumatic stress disorder exhibit similar hypocortisolism in the context of increased negative feedback sensitivity of the hypothalamic-pituitary-adrenal axis. Because trauma and posttraumatic stress disorder have been associated with fibromyalgia, the aim of this study was to evaluate whether patients with fibromyalgia demonstrate increased hypothalamic-pituitary-adrenal axis feedback sensitivity.

Methodology

Baseline blood samples were obtained in the morning, and 0.5 mg of dexamethasone was administered to 15 female patients with fibromyalgia and 20 normal controls in the evening. Adrenocorticotropin (ACTH), cortisol, and dexamethasone levels were measured the following morning.

Results

There were no group differences in mean ACTH or cortisol levels or in ACTH/cortisol ratio at baseline. After dexamethasone intake, patients with fibromyalgia exhibited more pronounced suppression of cortisol but not of ACTH, as well as increased ACTH/cortisol ratios compared with controls. Percent cortisol suppression was associated with pain and fatigue, while ACTH/cortisol ratio and dexamethasone availability were associated with stress and anxiety measures.

Conclusion

These results suggest increased sensitivity to cortisol feedback, manifested at the adrenal level, in fibromyalgia.

References

Wingenfeld K, Wagner D, Schmidt I, Meinlschmidt G, Hellhammer DH, Heim C. The low-dose dexamethasone suppression test in fibromyalgia. Journal of Psychosomatic Research 62 (1): 85-91, Jan 2007.

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