A comparison between low‐dose (1 µg), standard‐dose (250 µg) ACTH stimulation tests and insulin tolerance test in the evaluation of hypothalamo–pituitary–adrenal axis in primary fibromyalgia syndrome

Kırnap, Mehmet; Çolak, Ramiz; Eser, C.; Özsoy, O.; Tutuş, Ahmet; Keleştimur, Fahrettin

doi:10.1046/j.1365-2265.2001.01373.x

Cited by 37 publications

(19 citation statements)

References 23 publications

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“…It has been suggested that the 1 g ACTH test is more sensitive than a 250 μg ACTH test in the assessment of HPA axis activity. 21,22 In the present study, we found that both basal cortisol values and peak cortisol responses during LDT, SDT and ITT in AS patients were comparable to those in healthy controls. In contrast to findings in other inflammatory diseases such as rheumatoid arthritis and polymyalgia rheumatica, there is no apparent abnormality of HPA axis activity in patients with AS.…”

Section: Discussionsupporting

confidence: 71%

“…ITT has been accepted as the gold standard for the assessment of adrenal insufficiency. 20 We recently 21 evaluated the HPA axis of 16 patients with primary fibromyalgia syndrome and found that 6 out of the 16 patients had subnormal adrenal cortisol responses, which were revealed by LDT but not by SDT or ITT. It has been suggested that the 1 g ACTH test is more sensitive than a 250 μg ACTH test in the assessment of HPA axis activity.…”

Section: Discussionmentioning

confidence: 99%

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Hypothalamic-pituitary-adrenal axis in patients with ankylosing spondylitis

Kırnap¹,

Atmaca²,

Tanrıverdi³

et al. 2008

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OBjeCTive: To investigate the hypothalamic-pituitary-adrenal (HPA) axis via the insulintolerance test (iTT), standard-dose (250 μg) ACTH test (SDT) and low-dose (1 μg) ACTH test (LDT) in patients with ankylosing spondylitis (AS). DeSiGN:The study group included 13 male patients with AS who were diagnosed according to the Modified New York criteria, and 8 healthy male subjects and was carried out at the Department of Physical Medicine and Rehabilitation, erciyes University Medical School. ACTH stimulation tests were carried out by using 1 μg and 250 μg i.v. ACTH as a bolus injection, and blood samples were drawn at 0, 30 and 60 min. iTT was performed by using intravenous (i.v.) soluble insulin, and serum glucose and cortisol levels were measured before and after 30, 60, 90 and 120 min. All of the tests were performed consecutively with 3-day intervals, after an overnight fast. ReSULTS: There were no significant differences between the patients with AS (mean age 36.9±6.7 years) and the healthy subjects (mean age 37.4±5.7 years) in terms of age. The basal cortisol levels in the AS group measured during LDT, SDT and iTT (556±204 nmol/l; 524±169 nmol/l; 418±232 nmol/l, respectively) were comparable to the values of the control group (572±199 nmol/l; 520±182 nmol/l; 424±194 nmol/l, respectively). There were also no significant differences in peak cortisol responses between the two groups using LDT (patients 1025±339 nmol/l; controls 844±236 nmol/l), SDT (patients 1082±243 nmol/l; controls 1120±131 nmol/l) and iTT (patients 834±256 nmol/; controls 820±239 nmol/). CONCLUSiON: in contrast with findings in other inflammatory diseases such as rheumatoid arthritis and polymyalgia rheumatica, the present data indicate that there is no apparent abnormality of the HPA axis activity in patients with AS.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Hypothalamic-pituitary-adrenal axis in patients with ankylosing spondylitis

Kırnap¹,

Atmaca²,

Tanrıverdi³

et al. 2008

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“…First and foremost, studies that assess more than a single aspect of HPA axis function in the same group of patients are quite rare, as are studies that evaluate the same HPA response to several different tests [334,339,340,353,360,363,364]. This makes it difficult to discern a response pattern and to pinpoint the precise point within the HPA axis Metyrapone inhibits the 11β-hydroxylase enzyme that catalyzes the conversion of 11-deoxycortisol to cortisol in the adrenal gland and, therefore, results in increased ACTH release from the pituitary [622] DST dexamethasone suppression test where the defect occurs.…”

Section: Stress the Hpa Axis And The Autonomic Nervous Systemmentioning

confidence: 99%

Fibromyalgia: A Critical and Comprehensive Review

Borchers

Gershwin

2015

Clinic Rev Allerg Immunol

225

217

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Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.

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“…An alternative explanation for differential suppression at the pituitary and adrenal levels in FMS might involve effects of dexamethasone on ACTH-independent factors known to regulate adrenocortical activity, that is, autonomic innervation, immune input, or intra-adrenal peptides [46][47][48]. Enhanced direct and indirect feedback affecting the adrenal cortex might plausibly contribute to hypocortisolism in FMS and might in part explain reduced adrenocortical responsiveness to ACTH 1-24 stimulation in FMS [10,11]. Clearly, future studies are needed to specifically scrutinize the various pathways of adrenal regulation in FMS.…”

Section: Fmsmentioning

confidence: 99%

“…In the corticotropin-releasing factor (CRF) stimulation test, patients with FMS exhibit increased adrenocorticotropin (ACTH) but normal cortisol responses, suggesting sensitization of the pituitary in combination with adrenal insufficiency [7][8][9]. Reduced cortisol secretion has also been observed in response to ACTH 1-24 stimulation in FMS [10,11], although negative results have been reported as well [8]. Many of these findings are consistent with relative hypocortisolism in FMS.…”

Section: Introductionmentioning

confidence: 99%