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

OBJECTIVE Primary fibromyalgia syndrome (PFS) is a nonarticular rheumatological syndrome characterized by disturbances in the hypothalamo–pituitary–adrenal (HPA) axis. The site of the defect in the HPA axis is a matter of debate. Our aim was to evaluate the HPA axis by the insulin‐tolerance test (IT...

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Bibliographic Details
Published in:Clinical endocrinology (Oxford) 2001-10, Vol.55 (4), p.455-459
Main Authors: Kırnap, M., Çolak, R., Eser, C., Özsoy, O., Tutus, A., Kelestimur, F.
Format: Article
Language:English
Subjects:
Adrenocorticotropic Hormone - administration & dosage
Adult
Biological and medical sciences
Blood Glucose - analysis
Case-Control Studies
Diseases of striated muscles. Neuromuscular diseases
Drug Administration Schedule
Female
Fibromyalgia - physiopathology
Humans
Hydrocortisone - blood
Hypothalamo-Hypophyseal System - physiopathology
Insulin
Male
Medical sciences
Neurology
Pituitary-Adrenal System - physiopathology
Stimulation, Chemical
Tropical medicine
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Summary:OBJECTIVE Primary fibromyalgia syndrome (PFS) is a nonarticular rheumatological syndrome characterized by disturbances in the hypothalamo–pituitary–adrenal (HPA) axis. The site of the defect in the HPA axis is a matter of debate. Our aim was to evaluate the HPA axis by the insulin‐tolerance test (ITT), standard dose (250 µg) ACTH test (SDT) and low dose (1 µg) ACTH test (LDT) in patients with PFS. DESIGN AND PATIENTS Sixteen patients (13 female, three male) with PFS were included in the study. Sixteen healthy subjects (12 female, four male) served as matched controls. ACTH stimulation tests were carried out by using 1 µg and 250 µg intravenous (i.v.) ACTH as a bolus injection after an overnight fast, and blood samples were drawn at 0, 30 and 60 min. The ITT was performed by using i.v. soluble insulin, and serum glucose and cortisol levels were measured before and after 30, 60, 90 and 120 min. The 1 µg and 250 µg ACTH stimulation tests and the ITT were performed consecutively. RESULTS Peak cortisol responses to both the low dose test (LDT) and standard dose test (SDT) (589 ± 100 nmol/l; 777 ± 119 nmol/l, respectively) were lower in the PFS group than in the control group (1001 ± 370 nmol/l; 1205 ± 386 nmol/l, respectively) (P 
ISSN:0300-0664
1365-2265
DOI:10.1046/j.1365-2265.2001.01373.x