C. Heim et al., ABUSE-RELATED POSTTRAUMATIC-STRESS-DISORDER AND ALTERATIONS OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN WOMEN WITH CHRONIC PELVIC PAIN, Psychosomatic medicine, 60(3), 1998, pp. 309-318
Objective: Although numerous organic conditions may cause chronic pelv
ic pain (CPP), diagnostic laparoscopy reveals a normal pelvis in many
patients with CPP. However, psychological studies yield a high frequen
cy of psychopathology and increased prevalences of chronic stress and
traumatic life events, ie, sexual and physical abuse, in women with CP
P, suggesting a relationship between posttraumatic stress disorder (PT
SD) and CPP. As chronic stress and PTSD have been associated with spec
ific alterations of the hypothalamic-pituitary-adrenal (HPA) axis, we
explored stress history, psychopathology and HPA axis alterations in w
omen with CPP. Method: We recruited 16 patients with CPP and 14 painfr
ee, infertile controls from a general hospital where diagnostic laparo
scopy was performed. Psychological assessment included standardized in
terviews on clinical symptoms, abuse experiences and major Life events
as well as psychometric testing for PTSD-like symptoms and depression
. Endocrinological evaluation involved determinations of diurnal saliv
ary cortisol levels and hormonal responses to a corticotropin-releasin
g factor (CRF) stimulation test (100 mu g human CRF) and a low-dose de
xamethasone suppression test (0.5 mg). Results: We observed increased
prevalences of abuse experiences and PTSD in women with CPP as well as
a higher total number of major life events, whereas the mean extent o
f depression was within the normal range. With respect to endocrine me
asures, women with CPP demonstrated normal to low diurnal salivary cor
tisol levels, normal plasma-adrenocorticotropin (ACTH), but reduced sa
livary cortisol levels in the CRF stimulation test, and an enhanced su
ppression of salivary cortisol by dexamethasone. Conclusion: Women wit
h CPP demonstrate HPA axis alterations, that partly parallel and partl
y contrast neuroendocrine correlates of PTSD, but show marked similari
ty to findings in patients with other stress-related bodily disorders.
These findings suggest that a lack of protective properties of cortis
ol may be of relevance for the development of bodily disorders in chro
nically stressed or traumatized individuals.