Adrenal & Cortisol Status in Fibromyalgia: H-P-A Dysregulation

Fibromyalgia patients have stronger, measurable stress responses as measured by increased stress signals secreted by the pituitary to recruit more stress hormone production from the adrenals, ie the brain signals the stress system to activate.

In contrast, the adrenal glands demonstrate less ability to perform under stress and less ability to bounce back when stimulated.

The studies below substantiate what Fibromyalgia patients already know and live and what we often see in clinical practice – Fibromyalgia patients experience events much more intensely [ catastrophic ideation], and stress is very likely to induce anxiety, hypoglycemia and increase physical symptom burden like pain.

From a physiologic and body systems interrelationship perspective in functional medicine, there is so much more we do for Fibromyalgia patients than pain control, anti depressants, sedatives and sleep medicine. When you help compensate for neuro-endocrine dysregulation, sleep, mood, pain and sense of well being is much improved, a whole layer of medications become redundant, and you can pay more attention to the items that bring tangible lasting change and quality of life.

The low-dose dexamethasone suppression test in fibromyalgia.

This study observed increased sensitivity to glucocorticoid feedback, manifested at the adrenal level, in FMS. The interesting part of this study is that ACTH was normal after dexamethasone suppression testing, indicating normal Hypothalamic-Pituitary-Adrenal axis function, and that there was in internal negative feedback inhibition at the adrenal level or adrenal suppression as compared to healthy controls. Fibromyalgia patients adrenals have less bounce-back, is the final observation here.

 Enhanced reactivity of interleukin-6 levels and reduced glucocorticoid sensitivity in patients with fibromyalgia.

In this pain pressure threshold [stress] test on fibromyalgia patients, cortisol levels increased three fold, WITHOUT an in crease in ACTH. This is highly irregular and abnormal, indicating that the hypothalamic control is absent and that there is an endogenous organ level control over adrenal secretion of cortisol.

Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia.

This study explains very clearly, at the hormonal level, why Fibromyalgia patients have increased sensitivity to stress, lower stress tolerance, anxiety with stress, and need to eat a low carbohydrate diet that resembles the Paleo diet.

Studying the adrenal control system in Fibromyalgia patients, the effects of Corticotropin-releasing hormone (CRH) and insulin induced hypoglycemia in patients with Fibromyalgia caused dysregulation of the HPA axis in patients with Fibromyalgia.

Hypocortisolemia, hyperreactivity of pituitary ACTH release to CRH, and glucocorticoid feedback resistance.  There is a reduced containment of the stress-response system by corticosteroid hormones is associated with the symptoms of Fibromyalgia.


Werner Vosloo ND, MHom