The low-dose dexamethasone suppression test in fibromyalgia

Wingenfeld, Katja; Wagner, Dieter; Schmidt, Iris; Meinlschmidt, Gunther; Hellhammer, Dirk H.; Heim, Christine

doi:10.1016/j.jpsychores.2006.06.006

« Previous Next »Journal of Psychosomatic Research
Volume 62, Issue 1 , Pages 85-91, January 2007

The low-dose dexamethasone suppression test in fibromyalgia

Katja Wingenfeld
- Department of Psychobiology, University of Trier, Trier, Germany
- Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany
Dieter Wagner
- Department of Psychobiology, University of Trier, Trier, Germany
Iris Schmidt
- Department of Psychobiology, University of Trier, Trier, Germany
Gunther Meinlschmidt
- Department of Psychobiology, University of Trier, Trier, Germany
- Institute of Psychology, University of Basel, Basel, Switzerland
Dirk H. Hellhammer
- Department of Psychobiology, University of Trier, Trier, Germany
Christine Heim
- Department of Psychobiology, University of Trier, Trier, Germany
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Corresponding author. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, WMRB, Suite 4311, Atlanta, GA 30322, USA. Tel.: +1 404 727 5835; fax: +1 404 727 3233

Received 4 October 2005; received in revised form 24 April 2006; accepted 27 June 2006.

Abstract

Objective

Fibromyalgia syndrome (FMS) has been associated with decreased cortisol secretion. Patients with posttraumatic stress disorder (PTSD) exhibit similar hypocortisolism in the context of increased negative feedback sensitivity of the hypothalamic–pituitary–adrenal (HPA) axis. Because trauma and PTSD have been associated with fibromyalgia, we evaluated whether patients with fibromyalgia demonstrate increased HPA feedback sensitivity.

Method

Baseline blood samples were obtained at 0800 h, and 0.5 mg of dexamethasone was administered to 15 female patients with FMS and 20 normal controls at 2300 h. Adrenocorticotropin (ACTH), cortisol, and dexamethasone levels were measured at 0800 h after dexamethasone intake.

Results

There were no group differences in mean ACTH or cortisol levels or in ACTH/cortisol ratio at baseline. After dexamethasone intake, patients with FMS exhibited more pronounced suppression of cortisol but not of ACTH, as well as increased ACTH/cortisol ratios compared with controls. Percent cortisol suppression was associated with pain and fatigue, while ACTH/cortisol ratio and dexamethasone availability were associated with stress and anxiety measures.