Neuroendocrine abnormalities in fibromyalgia
Abstract
Fibromyalgia is a disorder of unknown etiology characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, poor sleep, gastrointestinal complaints, and psychologic problems that are similar to those experienced by patients with hormone deficiencies. This review summarizes the available data on the neuroendocrine function in fibromyalgia, including data on hormone secretion, circadian phase, and autonomic nervous system function. Studies suggest that there may be lower activity of a number of hypothalamic-pituitary-peripheral gland axes and altered autonomic nervous system function in patients with fibromyalgia. These reductions in activity are mild to moderate and do not result from alterations in circadian rhythms. The reduced hormonal and autonomic responses appear to reflect an impairment in the hypothalamic or central nervous system response to stimuli rather than a primary defect at the level of the pituitary gland or the peripheral glands. A combination of multiple, mild impaired responses may lead to more profound physiologic and clinical consequences as compared with a defect in only one system, and could contribute to the symptoms of fibromyalgia.
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Approximately 30% of female fibromyalgia patients exhibit a reduced adrenocorticotropic hormone and epinephrine response to hypoglycemia, associated with hypothalamic-pituitary-adrenal axis dysfunction.
“Approximately 30% of female FMS patients exhibit a reduced adrenocorticotropic hormone (ACTH) and epinephrine response to hypoglycemia. This phenomenon is associated with dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis in FMS patients.”
From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [43]
Reduced IGF-1 secretion may be attributed to imbalance of the hypothalamus-growth hormone-IGF-1 axis.
“Pulsatile growth hormone (GH), secreted by the anterior pituitary gland, stimulates the hepatic synthesis and secretion of IGF-1; therefore, reduced IGF-1 secretion may be attributed to the imbalance of the hypothalamus–growth hormone–IGF-1 axis (43).”
From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [43]
When hypoglycemia was controlled using the low-glycemic-high-insulin clamp technique, the ACTH response in fibromyalgia patients after a single insulin injection was reduced by 30% compared with healthy subjects.
“When the degree and duration of hypoglycemia were precisely controlled using the low-glycemic–high-insulin clamp technique, the ACTH response in FMS patients after a single insulin injection was reduced by 30% compared with healthy subjects (43).”
From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [43]
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- Authors
- Adler, G. K., Manfredsdottir, V. F., & Creskoff, K. W.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Adler, Gail K.
- Venue
- Current Pain and Headache Reports
- Published
- 2002-08
- Volume
- 6
- Issue
- 4
- Pages
- 289-298
- ISSN
- 1531-3433 (ISSN-L)
- 1534-3081
- OpenAlex
- W1983415808
- Cited by
- 51
- References
- 83
- Citations by year
- 2026: 2 · 2025: 1 · 2021: 4 · 2020: 2 · 2019: 1 · 2016: 1 · 2015: 2 · 2014: 4 · 2013: 1 · 2012: 2
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Pain and Headache Reports (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01-AR43130, R01AR043130)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- fibromyalgia, neuroendocrine abnormalities, autonomic dysfunction, circadian rhythm, hormone secretion, chronic widespread pain, fatigue, sleep disorders, gastrointestinal symptoms
- MeSH terms
- Autonomic Nervous System, Circadian Rhythm, Fibromyalgia, Hormones, Humans, Hypothalamo-Hypophyseal System, Neurosecretory Systems, Pituitary-Adrenal System
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