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

From the Department of Psychobiology, University of Trier, Trier, Germany (K.W., C.H., I.S., D.W., G.M., D.H.H.); Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany (K.W.); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA (C.H.); and Institute of Psychology, University of Basel, Switzerland (G.M.).

Address correspondence and reprint requests to Katja Wingenfeld, PhD, Department of Psychiatry and Psychotherapy, Bethel, Remterweg 69–71, 33617 Bielefeld, Germany. E-mail: katja.wingenfeld{at}evkb.de

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.

Key Words: chronic pelvic pain • fibromyalgia syndrome • hypothalamic-pituitary-adrenal axis • cortisol • glucocorticoid sensitivity

Abbreviations: FMS = fibromyalgia syndrome; CPP = chronic pelvic pain; HPA = hypothalamic-pituitary-adrenal; TSST = Trier Social Stress Test; ACTH = adrenocorticotropin; GC = glucocorticoid; GR = glucocorticoid receptor; BMI = body mass index; LPS = lipopolysaccharide; IL-6 = interleukin-6; TNF- = tumor necrosis factor-alpha.