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Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain
GRIEP E. N. ; BOERSMA J. W. ; LENTJES E. G. W. M. ; ...
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 i
Journal of Rheumatology Publishing
PMID : 9676772 ISSN : 0315-162X CODEN : JRHUA9
Journal of rheumatology A. 1998, vol. 25, n° 7, pp. 1374-1381 [bibl. : 51 ref.]
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