Hyposecretion of adrenal androgens and the relation of serum adrenal steroids, serotonin and insulin-like growth factor-1 to clinical features in women with fibromyalgia

Neuroendocrine deficiencies have been implicated in fibromyalgia (FM). In t he present study, adrenal androgen metabolites and their relationship with health status in FM were investigated. For comparison, serum levels of othe r implicated neuroendocrine mediators were correlated with health status. F ifty-seven consecutive women with FM completed the Fibromyalgia Impact Ques tionnaire (FIQ). Fasting blood samples were taken for measurement of dehydr oepiandrosterone sulphate (DHEAS), free testosterone (T), cortisol, seroton in and insulin-like growth factor-1. Normal value for DHEAS and T were obta ined from 114 controls. DHEAS levels were decreased significantly in pre- a nd postmenopausal patients (P < 0.0001 and P < 0.0005, respectively). T lev els were decreased significantly in premenopausal and insignificantly in po stmenopausal patients (P < 0.0001 and P = 0.06, respectively). The followin g correlations between neurohormonal levels and FIQ scores were found: DHEA S (after adjustment for age) vs. pain (P < 0.001) and T (after adjustment f or age) versus physical functioning (P = 0.002). None of the other neurohor monal levels correlated significantly with any of the FIQ scores. IGF-1 lev els were lower in the obese patients as compared to those who were non-obes e (P = 0.03). The BMI correlated positively with pain (P < 0.001) and inver sely with DHEAS levels (P = 0.006). After further adjustment for BMI, the c orrelation between age adjusted DHEAS and pain was no longer significant. H yposecretion of adrenal androgens was documented in FM. This was more prono unced in obese patients. Low serum androgen levels correlated with poor hea lth status in FM. Longitudinal studies are needed to elucidate whether thes e are cause and/or effect relationships. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.