IS FIBROMYALGIA A SYNDROME OF HORMONAL IMBALANCE?

Authors

  • Suman Tanwar Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
  • Bhawna Mattoo Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
  • Uma Kumar Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India.
  • Nandita Gupta Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
  • Renu Bhatia Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

DOI:

https://doi.org/10.22159/ajpcr.2018.v11i7.24016

Keywords:

Fibromyalgia syndrome, Cortisol, Thyroid-stimulating hormone

Abstract

Objectives: The present study was conducted to estimate cortisol and thyroid-stimulating hormone (TSH) levels in patients with fibromyalgia syndrome (FMS) and to find correlation if any between hormone levels and pain duration in FMS.

Methods: Plasma cortisol and TSH concentration were determined by electro chemiluminescence immunoassay in 89 female patients with FMS and 74 age-matched healthy women.

Results: No significant difference in TSH level was observed between FMS and healthy subjects. Ten patients had higher cortisol levels than the standard reference range, 48 patients with reduced cortisol and 31 patients with normal cortisol levels. No significant correlation was observed between pain duration and levels of cortisol.

Conclusion: The study has confirmed the equivocal data regarding cortisol/hypothalamic-pituitary-adrenal axis related dysfunction in FMS. To the best of our knowledge, it is the first Indian study on FMS which assessed the cortisol and TSH levels and their correlation with pain duration if any.

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Author Biographies

Suman Tanwar, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

PhD Scholar, Dept. of Physiology

Bhawna Mattoo, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

Senior Resident, Dept. of Physiology

Uma Kumar, Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India.

Professor & Head,

Department of  Rheumatology

Nandita Gupta, Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.

Professor

Department of  Endocrinology

Renu Bhatia, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

Associate Professor,

Department of  Physiology

References

Hudson JI, Pope HG Jr. The relationship between fibromyalgia and major depressive disorder. Rheum Dis Clin North Am 1996;22:285-303.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American college of rheumatology 1990 criteria for the classification of fibromyalgia: Report of the multicenter criteria committee. Arthritis Rheum 1990;33:160-72.

Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995;38:19-28.

Ahles TA, Yunus MB, Riley SD, Bradley JM, Masi AT. Psychological factors associated with primary fibromyalgia syndrome. Arthritis Rheum 1984;27:1101-6.

Uveges JM, Parker JC, Smarr KL, McGowan JF, Lyon MG, Irvin WS, et al. Psychological symptoms in primary fibromyalgia syndrome: Relationship to pain, life stress, and sleep disturbance. Arthritis Rheum 1990;33:1279-83.

Dailey PA, Bishop GD, Russell IJ, Fletcher EM. Cortisol secretion in FM and RA 59 chological stress and the fibrositis/fibromyalgia syndrome. J Rheumatol 1990;17:1380-5.

Thomason BT, Brantley PJ, Jones GN, Dyer HR, Morris JL. The relation between stress and disease activity in rheumatoid arthritis. J Behav Med 1992;15:215-20.

Thomas AB, Dubey SK, Samanta MK, Alex A, Jose SP. Assessment of psychological stressors of depression and anxiety using depression anxiety stress scale-21 in South Indian healthy volunteers. Int J Pharm Pharm Sci 2016;8:288-95.

Sridevi G, Sembulingam K, Sembulingam P, Ibrahim M, Srividya S. Evaluation of stress alleviating potential of Pergularia daemia on certain immunological parameters. Int J Pharm Pharm Sci 2016;8:266-70.

Izquierdo-Alvarez S, Bocos-Terraz, JP, Bancalero-Flores, JL, Pavon- Romero L, Serrano-Ostariz E, de Miquel CA. Is there an association between fibromyalgia and below-normal levels of urinary cortisol? BMC Res Notes 2008;1:134.

Korszun A, Young AE, Engleberg NC, Masterson L, Dawson EC, Spindler K, et al. Follicular phase hypothalamic-pituitary-gonadal axis function in women with fibromiyalgia and chronic fatigue syndrome. J Rheumatol 2000;27:1526-30.

McLean SA, Williams DA, Harris RE, Kop WJ, Groner KH, Ambrose K, et al. Momentary relationship between cortisol secretion and symptoms in patients with fibromyalgia. Arthritis Rheum 2005;52:3660-9.

McBeth J, Chiu YH, Silman AJ, Ray D, Morriss R, Dickens C, et al. Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents. Arthritis Res Ther 2005;7:R992-1000.

Wolfe F, Hawley DJ. Evidence of disordered symptom appraisal in fibromyalgia: Increased rates of reported comorbidity and comorbidity severity. Clin Exp Rheumatol 1999;17:297-303.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS,Mease P, et al. The American college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010;62:600-10.

Bazzichi L, Rossi A, Zirafa C, Monzani F, Tognini S, Dardano A, et al. Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia? Rheumatol Int 2012;32:335-41.

Garrison RL, Breeding PC. A metabolic basis for fibromyalgia and its related disorders: The possible role of resistance to thyroid hormone. Med Hypotheses 2003;61:182-9.

Soy M, Guldiken S, Arikan E, Altun BU, Tugrul A. Frequency of rheumatic diseases in patients with autoimmune thyroid disease. Rheumatol Int 2007;27:575-7.

Ribeiro LS, Proietti FA. Interrelations between fibromyalgia, thyroid autoantibodies, and depression. J Rheumatol 2004;31:2036-40.

Gur A, Cevik R, Sarac AJ, Colpan L, Em S. Hypothalamic-pituitary-gonadal axis and cortisol in young women with primary fibromyalgia: The potential roles of depression, fatigue, and sleep disturbance in the occurrence of hypocortisolism. Ann Rheum Dis 2004;63:1504-6.

Wingenfeld K, Wagner, D, Schmidt I, Meinlschmidt G, Hellhammer DH, Heim, C. The low-dose dexamethasone suppression test in fibromyalgia. J Psychosom Res 2007;62:85-91.

Wingenfeld K, Heim C, Schmidt I, Wagner D, Meinlschmidt G, Hellhammer DH. HPA axis reactivity and lymphocyte glucocorticoid sensitivity in fibromyalgia syndrome and chronic pelvic pain. Psychosom Med 2008;70:65-72.

Crofford LJ, Pillemer SR, Kalogeras KT, Cash JM, Michelson D, Kling MA, et al. Hypothalamic-pituitary-adrenal axis perturbations in patients with fibromyalgia. Arthritis Rheum 1994;37:1583-92.

McCain GA, Tilbe KS. Diurnal hormone variation in fibromyalgia syndrome: A comparison with rheumatoid arthritis. J Rheumatol 1989;16:154-7.

Adler GK, Kinsely BT, Hurwitz S, Mossey CJ, Goldenberg DL. Reduced Hypothalamic-pituitary and sympthoadrenal response to hypoglycaemia in women with fibromyalgia syndrome. Am J Med 1999;106:534-43.

Crofford LJ, Young EA, Engleberg NC. Basal circadian and pulsatile ACTH and cortisol secretion in patients with fibromyalgia and/or chronic fatigue syndrome. Brain Behav Immun 2004;18:314-32.

Wingenfeld K, Nutzinger D, Kauth J, Hellhammer DH, Lautenbacher S. Salivary cortisol release and hypothalamic pituitary adrenal axis feedback sensitivity in fibromyalgia is associated with depression but not with pain. J Pain 2010;11:1195-202.

Lowe JC. T3-induced recovery from fibromyalgia by a hypothyroid patient resistant to T4 and desiccated thyroid. J Myofascial Ther 1995;1:26-31.

Lowe JC, Garrison RL, Reichman AJ, Yellin J, Thompson M, Kaufman D. Effectiveness and safety of T3 (triiodothyronine) theraphy for euthyroid fibromyalgia: A double-blind placebo-controlled response-driven crossover study. Clin Bull Myofascial Ther 1997;2:71-88.

Lowe JC, Eichelberger J, Manso G, Peterson K. Improvement in euthyroid fibromyalgia patients treated with T3 triiodothyronine. J Myofascial Ther 1994;1:16-27.

Toruner F. Association of Fibromyalgia with Hashimoto’s Thyroiditis. Turkey: European Thyroid Association Annual Meeting Istanbul; 2004.

Bazzichi, L, Rossi, A, Giuliano, T, De Feo F, Giacomelli C, Consensi A, et al. Association between thyroid autoimmunity and fibromyalgic disease severity. Clin Rheumatol 2007;26:2115-20.

Pamuk ON, Cakir N. The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms. Clin Rheumatol 2007;26:55-9.

Ruchala M, Kosowicz J, Baumann-Antczak A, Skiba A, Zamyslowska H, Sowinski J. The prevalence of autoantibodies to: Myosin, troponin, tropomyosin and myoglobin in patients with circulating triiodothyronine and thyroxine autoantibodies (THAA). Neuro Endocrinol Lett 2007;28:259-66.

Sarne DH, Refetoff S. Measurement of thyroxine uptake from serum by cultured human hepatocytes as an index of thyroid status: Reduced thyroxine uptake from serum of patients with nonthyroidal illness. J Clin Endocrinol Metab 1985;61:1046-52.

Walter KN, Elizabeth J, Corwin JU, Laurence MD, Bennett JM, Whetzel CA. Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women. Thyroid Res 2012;5:13.

Iranmanesh A, Lizarralde G, Johnson ML, Veldhuis JD. Dynamics of 24-hour endogenous cortisol secretion and clearance in primary hypothyroidism assessed before and after partial thyroid hormone replacement. J Clin Endocrinol Meta 1990;70:155-61.

Weigent DA, Bradley LA, Blalock JE, Alarcon GS. Current concepts in the pathophysiology of abnormal pain perception in fibromyalgia. Am J Med Sci 1998;315:405-12.

Abd-Rabou AA, Ahmed HH, Eskander EF. Clemastine, the H1 histamine receptor antagonist, alters the human sex and thyroid hormonal profiles. Asian J Pharm Clin Res 2017;10:327-30.

Nath C, Sarma A, Phukan P, Rajkhowa P, Ahmed F, Baruah M, et al. A study on concomitant occurrence of subclinical hypothyroidism and reduced growth hormone secretion on fibromyalgia. J Evid Based Med Healthcare 2015;2:3735-41.

Fauci AS, Kasper DL, Longo DL, Braunwald E, Jameson L, Loscalzo J. Harrison’s Principles of Internal Medicine. 17th ed. Ch. 329. New York: McGraw-Hill; 2008.

Hardik S, Divya R, Maitreyi Z, Sonal P, Ghanashyam P. Pharmacological evaluation of ranger syrup by studying acute toxicity, in-vitro anti-oxidant property and in-vivo anti-stress activity. Asian J Pharm Clin Res 2014;7:13-6.

Cevik R, Gur A, Acar S, Nas K, Sarac AE. Hypothalamic-pituitary-gonadal axis hormones and cortisol in both menstrual phases of women with chronic fatigue syndrome and effect of depressive mood on these hormones. BMC Musculoskeletal Disord 2004;5:47.

Bellato E, Marini E, Castoldi F, Barbasetti N, Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res Treatm 2012;2012:17.

Fries E, Hesse J, Hellhammer J, Hellhammer DH. A new view on hypocortisolism. Psychoneuroendocrinology 2005;30:1010-6.

Fabian LA, McGuire L, Page GG, Goodin BR, Edwards RR, Haythornthwaite J. The association of the cortisol awakening response with experimental pain ratings. Psychoneuroendocrinology 2009;34:1247-51.

Kumari M, Badrick E, Chandola T, Adam EK, Stafford M, Marmot MG, et al. Cortisol secretion and fatigue: Associations in a community based cohort. Psychoneuroendocrinology 2009;34:1476-85.

O’Connor DB, Hendrickx H, Dadd T, Elliman TD, Willis TA, Talbot D, et al. Cortisol awakening rise in middle-aged women in relation to psychological stress. Psychoneuroendocrinology 2009;34:1486-94.

Griep EN, Boersma JW, de Kloet ER. Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. J Rheumatol 1993;20:469-74.

Griep EN, Boersma JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER. Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J Rheumatol 1997;25:1374-81.

Ferraccioli G, Cavalieri F, Salaffi F, Fontana S, Scita F, Nolli M, et al. Neuroendocrinologic findings in primary fibromyalgia (soft tissue chronic pain syndrome) and in other chronic rheumatic conditions (rheumatoid arthritis, low back pain). J Rheumatol 1990;17:869-73.

Arnold LM. The pathophysiology, diagnosis and treatment of fibromyalgia. Psychiatr. Clin North Am 2010;33:375-408.

Riva R, Mork PJ, Westgaard RH, Ro M, Lundberg U. Fibromyalgia syndrome is associated with hypocortisolism. Int J Behav Med 2010;17:223-33.

Catley D, Kaell AT, Kirschbaum C, Stone AA. A naturalistic evaluation of cortisol secretion in persons with fibromyalgia and rheumatoid arthritis. Arthritis Care Res 2000;13:51-61.

Published

07-07-2018

How to Cite

Tanwar, S., B. Mattoo, U. Kumar, N. Gupta, and R. Bhatia. “IS FIBROMYALGIA A SYNDROME OF HORMONAL IMBALANCE?”. Asian Journal of Pharmaceutical and Clinical Research, vol. 11, no. 7, July 2018, pp. 416-20, doi:10.22159/ajpcr.2018.v11i7.24016.

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