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





Adrenal & Cortisol Status in Fibromyalgia: Not Enough Cortisol

Fibromyalgia is characterized by a lack of energy, drive & motivation and a general lack of “get-up-and-go”. Mornings are pretty bad, you feel more tired than when you went to bed.

Cortisol levels in the mornings and also throughout the rest of the day are much lower than you need to get through the day’s stress, fatigue and pain.

Adrenal dysfunction is strongly responsible for this lack of restorative sleep or not feeling rested in the morning.

Cortisol is a key adrenal hormone that is essential to maintain healthy:

  • Blood glucose levels   
  • Converting fat, protein and carbohydrate to maintain blood sugar  
  • Immune balance and healthy immune responses    
  • Endogenous anti-inflammatory [more allergies and inflammation when cortisol low]  
  • Blood Pressure
  • Heart and blood vessel tone and contraction
  • Central nervous system activation and motivation
  • Healthy and happy optimistic mood  
  • Stress tolerance
  • Sleep and day-night cycles

Just like thyroid hormone, it is very safe and easy to correct low cortisol levels.

Evaluation consists of symptomatic evaluation and laboratory investigation of cortisol levels at 4 different times of the day, or total cortisol production for a whole day.


Studies to read:

Comparison of the cortisol awakening response in women with shoulder and neck pain and women with fibromyalgia.

Fibromyalgia patients have lower cortisol levels than woman with shoulder and neck pain. Fibromyalgia patients have more symptom burden: pain levels, sleeping problems, perceived stress, and psychological problems related to their condition.


Fibromyalgia syndrome is associated with low cortisol.

Fibromyalgia patients had significantly lower cortisol levels during the day, most pronounced in the morning . As expected, Fibromyalgia patients reported more pain, stress, sleeping problems, anxiety, and depression.

This confirms dysfunction in the hypothalamus-pituitary-adrenal axis in Fibromyalgia patients, with generally lower cortisol values, most pronounced upon awakening.


Delineating Psychological and Biomedical Profiles in a Heterogeneous Fibromyalgia Population Using Cluster Analysis 

An analysis of various subgroups of Fibromyalgia patients indicated that the more symptomatic patients with more severe pain and disability had the lowest levels of cortisol.

Childhood abuse and family dysfunction is reported in 64% of fibromyalgia cases.

When present in the history, there was a greater tendency to a flattened day-night cortisol curve with lower cortisol production.


Werner Vosloo ND MHom


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