title: The low-dose dexamethasone suppression test in fibromyalgia.
abstract: OBJECTIVE
  Fibromyalgia syndrome (FMS) has been associated with decreased cortisol secretion. Patients with posttraumatic stress disorder (PTSD) exhibit similar hypocortisolism in the context of increased negative feedback sensitivity of the hypothalamic-pituitary-adrenal (HPA) axis. Because trauma and PTSD have been associated with fibromyalgia, we evaluated whether patients with fibromyalgia demonstrate increased HPA feedback sensitivity.
  
  
  METHODS
  Baseline blood samples were obtained at 0800 h, and 0.5 mg of dexamethasone was administered to 15 female patients with FMS and 20 normal controls at 2300 h. Adrenocorticotropin (ACTH), cortisol, and dexamethasone levels were measured at 0800 h after dexamethasone intake.
  
  
  RESULTS
  There were no group differences in mean ACTH or cortisol levels or in ACTH/cortisol ratio at baseline. After dexamethasone intake, patients with FMS 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.
  
  
  CONCLUSIONS
  Our results suggest increased sensitivity to glucocorticoid feedback, manifested at the adrenal level, in FMS.
authors.affiliation: Department of Psychobiology, University of Trier, Trier, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Wingenfeld
authors.forename: Dieter
authors.initials: D
authors.lastname: Wagner
authors.forename: Iris
authors.initials: I
authors.lastname: Schmidt
authors.forename: Gunther
authors.initials: G
authors.lastname: Meinlschmidt
authors.forename: Dirk H
authors.initials: DH
authors.lastname: Hellhammer
authors.forename: Christine
authors.initials: C
authors.lastname: Heim
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D001007:Anxiety / Q000097:blood / Q000523:psychology; D001676:Biofeedback, Psychology / Q000502:physiology; D003863:Depression / Q000097:blood / Q000523:psychology; D003907:Dexamethasone / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005221:Fatigue / Q000097:blood / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000097:blood* / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008875:Middle Aged; D010146:Pain / Q000097:blood / Q000523:psychology; D010913:Pituitary-Adrenal System / Q000503:physiopathology
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone