Our results suggest normal HPA responses to stress and ACTH stimulation in patients with CPP but reduced adrenal reactivity in patients with FMS, name

Psychosomatic Medicine 70:65-72 (2008)
© 2008 American Psychosomatic Society
ORIGINAL ARTICLES
HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in
Fibromyalgia Syndrome and Chronic Pelvic Pain
Katja Wingenfeld, PhD, Christine Heim, PhD, Iris Schmidt, PhD, Dieter
Wagner, PhD, Gunther Meinlschmidt, PhD and Dirk H. Hellhammer, PhD

From the Department of Psychobiology, University of Trier, Trier,
Germany (K.W., C.H., I.S., D.W., G.M., D.H.H.); Department of
Psychiatry and Psychotherapy Bethel, Bielefeld, Germany (K.W.);
Department of Psychiatry and Behavioral Sciences, Emory University
School of Medicine, Atlanta, GA (C.H.); and Institute of Psychology,
University of Basel, Switzerland (G.M.).

Address correspondence and reprint requests to Katja Wingenfeld, PhD,
Department of Psychiatry and Psychotherapy, Bethel, Remterweg 69–71,
33617 Bielefeld, Germany. E-mail: katja.wingenfeld@evkb.de

Objective: Chronic pelvic pain (CPP) and fibromyalgia syndrome (FMS)
have been associated with hypothalamic-pituitary-adrenal (HPA) axis
alterations, i.e., mild hypocortisolism and enhanced feedback
sensitivity. We tested the hypothesis of reduced cortisol release in
response to a psychosocial stressor and pharmacological stimulation.
Furthermore, glucocorticoid (GC) sensitivity was evaluated.

Methods: Plasma total and salivary-free cortisol concentrations were
measured in response to a standardized social laboratory stressor, the
Trier Social Stress Test, and to adrenocorticotropin (ACTH)1–24
stimulation. In the Trier Social Stress Test, we additionally measured
ACTH. GC sensitivity was measured by dexamethasone inhibition of
lipopolysaccharide-induced interleukin-6 and tumor necrosis factor-
alpha production in whole blood.

Results: There were no HPA axis alterations in women with CPP (N = 18)
in these tests. Patients with FMS (N = 17) showed lower total cortisol
release in response to the social stressor and exogenous ACTH, but
normal free cortisol and ACTH levels compared with controls (N = 24).
GC sensitivity was similar in all groups.

Conclusions: Our results suggest normal HPA responses to stress and
ACTH stimulation in patients with CPP but reduced adrenal reactivity
in patients with FMS, namely in total cortisol release. Free cortisol
on the other hand was unaltered, possibly reflecting an adaptation to
reduced circulating total cortisol.

Key Words: chronic pelvic pain • fibromyalgia syndrome • hypothalamic-
pituitary-adrenal axis • cortisol • glucocorticoid sensitivity

Abbreviations: FMS = fibromyalgia syndrome; CPP = chronic pelvic pain;
HPA = hypothalamic-pituitary-adrenal; TSST = Trier Social Stress Test;
ACTH = adrenocorticotropin; GC = glucocorticoid; GR = glucocorticoid
receptor; BMI = body mass index; LPS = lipopolysaccharide; IL-6 =
interleukin-6; TNF-{alpha} = tumor necrosis factor-alpha.

Effect of Social Support on Nocturnal Blood Pressure Dipping

Effect of Social Support on Nocturnal Blood Pressure Dipping
Carlos J. Rodriguez, MD, MPH, Matthew M. Burg, PhD, Joyce Meng, MD,
Thomas G. Pickering, MD, DPhil, Zhezhen Jin, PhD, Ralph L. Sacco, MD,
MS, Bernadette Boden-Albala, DrPH, Shunichi Homma, MD and Marco R. Di
Tullio, MD

From the Department of Medicine (C.J.R., M.M.B., J.M., T.G.P., S.H.,
M.R.D.T.), Columbia University, New York, New York; Department of
Neurology (R.L.S., B.B.-A.), Columbia University, New York, New York;
Department of Epidemiology (C.J.R., R.L.S.), Columbia University,
Mailman School of Public Health, New York, New York; Department of
Sociomedical Science (B.B.-A.), Columbia University, Mailman School of
Public Health, New York, New York; Department of Biostatistics (Z.J.),
Columbia University, Mailman School of Public Health, New York, New
York; Department of Neurology (R.L.S.), University of Miami, Miami,
Florida; and Section of Cardiovascular Medicine (M.W.B.), Yale
University, New Haven, Connecticut.

Address correspondence and reprint requests to Carlos J. Rodriguez,
Division of Cardiology, Columbia University, 622 W 168th street; PH
3-342, New York, NY 10032. E-mail: cjr10@columbia.edu

Objective: To determine if nocturnal blood pressure (BP) dipping among
non-Hispanic blacks is influenced by social support. Non-Hispanic
blacks have higher rates of cardiovascular morbidity and mortality
from hypertension and are more likely to have ambulatory blood
pressure (ABP) that remains high at night (nondipping).

Methods: A total of 68 non-Hispanic black normotensive and 13
untreated hypertensive participants (age 72 ± 10 years, 48% female)
free of clinical cardiovascular disease completed 24-hour ABP
monitoring and a questionnaire that included a modified version of the
CARDIA Study Social Support Scale (CSSS). Nondipping was defined as a
decrease of <10% in the ratio between average awake and average asleep
systolic BP. Analyses were adjusted for age, gender, and systolic BP.

Results: The prevalence of nondipping was 26.8% in subjects in the
highest CSSS tertile versus 41.1% in the lowest CSSS tertile (p = .
009). On adjusted analysis, CSSS was analyzed as a continuous variable
and remained independently and inversely associated with nondipping
(odds ratio 0.27, 95% Confidence Interval 0.08–0.94, p = .04).

Conclusions: Social support may be an important predictor of BP
dipping at night. These findings suggest that social support may have
positive health affects through physiologic (autonomic) pathways.

Key Words: ambulatory blood pressure monitoring • social support •
African-Americans • hypertension

Abbreviations: BP = blood pressure; ABP = ambulatory blood pressure;
NOMASS = Northern Manhattan Stroke Study; CSSS = CARDIA Social Support
Scale; BMI = body mass index; OR = odds ratio; SD = standard deviation.