© 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.
