title: HPA axis reactivity and lymphocyte glucocorticoid sensitivity in fibromyalgia syndrome and chronic pelvic pain.
abstract: 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.
authors.affiliation: Department of Psychobiology, University of Trier, Trier, Germany. katja.wingenfeld@evkb.de
authors.forename: Katja
authors.initials: K
authors.lastname: Wingenfeld
authors.forename: Christine
authors.initials: C
authors.lastname: Heim
authors.forename: Iris
authors.initials: I
authors.lastname: Schmidt
authors.forename: Dieter
authors.initials: D
authors.lastname: Wagner
authors.forename: Gunther
authors.initials: G
authors.lastname: Meinlschmidt
authors.forename: Dirk H
authors.initials: DH
authors.lastname: Hellhammer
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D002908:Chronic Disease; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008875:Middle Aged; D017699:Pelvic Pain / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone